LIBRARY OF CONGRESS. 



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UNITED STATES OF AMERICA. 



A TEXT-BOOK 



OF 



PRACTICAL THERAPEUTICS, 



WITH ESPECIAL REFERENCE TO THE 



APPLICATION OF REMEDIAL MEASURES TO DISEASE 



AND THEIR 



EMPLOYMENT UPON A RATIONAL BASIS. 



BY 

HOBART AMORY HARE, M.D., B.Sa, 

PROFESSOR OF THERAPEUTICS AND MATERIA MEDICA IN THE JEFFERSON MEDICAL COLLEGE OF 
PHILADELPHIA; PHYSICIAN TO THE JEFFERSON MEDICAL COLLEGE HOSPITAL ; CONSULT- 
ING PHYSICIAN TO THE FRANKLIN REFORMATORY HOME; LAUREATE OF THE 
ROYAL ACADEMY OF MEDICINE IN BELGIUM, OF THE MEDICAL SOCIETY 
OF LONDON; CORRESPONDING FELLOW OF THE SOCIEDAD 
ESPANOLA DE HIGIENE OF MADRID, ETC. 



FIFTH EDITION, ENLARGED AND THOROUGHLY REVISED. 





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PHILADELPHIA: 

LEA BROTHERS & CO. 

18 9 5. 



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Entered according to Act of Congress, in the year 1895, by 

LEA BROTHERS & CO, 

in the Office of the Librarian of Congress. All rights reserved. 



Westcott & Thomson, 
Stereotypes and Electrotyper.s, Philada. 



THIS VOLUME 

IS DEDICATED TO 
Dr. J. WILLIAM WHITE, 

PROFESSOK OF CLINICAL SURGERY IN THE UNIVERSITY OP PENNSYLVANIA, 

AS AN 

EVIDENCE OF FRIENDSHIP AND ESTEEM, 



THE AUTHOR 



PREFACE TO THE FIFTH EDITION. 



The call for the fifth edition of The Text-book of Thera- 
peutics within five years after the first edition appeared has encour- 
aged the author to use every effort to make the work of practical 
use to the active practitioner, and has enabled him to keep the text 
abreast of the latest advances which are reliable. In the present 
edition each article has been revised, many useful suggestions added, 
several articles entirely rewritten, and the antitoxin treatment of 
diphtheria discussed. 

Philadelphia, 222 South Fifteenth Street, 
June, 1895. 



PREFACE TO THE FOURTH EDITION. 



The Fourth Edition of this work having been called for in less 
than four years after the appearance of the first, the Author has 
taken advantage of the opportunity to rewrite and add to many of 
the articles on drugs, remedial measures, and diseases, and to insert 
practical information concerning the value and prescription of the 
really useful new remedies. Articles on Methylene Blue, Chloralose, 
Pyrogallol, Condurango, Convallaria, Duboisine, and other remedies 
have been added to the part of the work dealing with drugs. In 
the part dealing with Remedial Measures other than Drugs articles 
have been written on Hypodermoclysis and Enteroclysis, Lavage, 
and upon Mineral Springs and Climatic Treatment. The latter 
article is not intended to be exhaustive, but to give the general 
practitioner an idea of the therapeutic value of certain well-known 
resorts, in order that he may offer rational advice to his patients as 
to where they should go in search of health. Several new articles 
in the part devoted to the Treatment of Individual Diseases have 
been inserted, and new or modified applications of the older remedies 
carefully noted throughout the entire book. 

In addition to these changes, the work has been revised in such a 
way as to render it uniform with the new U. S. Pharmacopoeia. As 
that authority directs the use of the metric system, the doses of all 
drugs are given in both Apothecaries' and Metric weights, thus 
(15 to 30 grains [1.0-2.0]), so that the physician may conveniently 
use either system, but it is to be clearly understood that where the 
doses are expressed in both systems, side by side, no attempt has 
been made to make the metric amounts more than approximate the 
quantities given in Troy weight. 



PREFACE TO THE FOURTH EDITION. 7 

The fact that one fluidounce is nearly represented by 30 cc., 
while one solid ounce is represented approximately by 32 grammes, 
causes confusion. The author has therefore adopted the method 
advised by Oldberg in his valuable and well-known "Manual of 
Weights and Measures," and used 32 cubic centimetres or grammes 
as equivalent to 1 ounce, whether liquid or solid. 

The Author desires to express his appreciation of the care with 
which Dr. de Schweinitz has revised the articles on Diseases of the 
Eye ; Dr. Hirst, those on the Puerperal State ; and Dr. Martin, those 
on Syphilis and Genito-urinary Diseases and Antisepsis. The arti- 
cles on the treatment of diseases of the upper air-passages have been 
rewritten or revised by the Author. 

It is hoped that this new edition will prove even more useful than 
its predecessors to the doctor who needs a book for ready reference in 
daily practice. 

Philadelphia, 222 South Fifteenth Street. 



PREFACE TO THE FIRST EDITION. 



The object of this book is to provide the physician or under- 
graduate student of medicine with a reliable guide in the study of 
Therapeutics, or the application of remedial measures for the cure 
of disease. It has been written because, in the belief of the author, 
most of the text-books on this subject treat of it as if the student were 
already a skilled physician or experimental pharmacologist. As a 
consequence, two classes of undergraduate readers exist. One finds 
that the mixture of science and empiricism is too difficult for him to 
fathom, and is hopelessly confused; the other simply learns the reme- 
dies and doses by heart, and gives drugs with little idea as to what 
they are to do. Further than this, the physician is often at a loss to 
decide when a remedy is indicated, even though his theoretical know- 
ledge of the subject be very thorough. Thus, he is told that ammo- 
nium chloride is a remedy in bronchitis, but the exact stage at which 
it is to be employed is often not stated ; or he knows that digitalis 
does good in cases of cardiac disease, but fails to recognize the fact 
that it is only when compensation is lacking that the drug is needed. 
For this reason Part IV. has been written, not with the object of 
providing a rigid system for treating disease, but rather for the pur- 
pose of bringing together the best remedies, and of showing how and 
why they are given. 

Rational therapeutics at the present day does not consist in a 
knowledge of doses and the materia medica, but exists as a complex 
art in which knowledge and its proper application, based on common- 
sense principles, go hand in hand. The treatment of " symptoms as 
they arise" by the employment of remedies recommended by some 
eminent authority is a variety of empiricism whose existence has 



PREFACE TO THE FIRST EDITION. 9 

depended largely on the fact that many physicians of the past have 
either been so ignorant as to be led where a writer willed, or so sloth- 
ful as to be willing to let others think for them. Scientific research 
has so largely opened up to every one the possibility of using drugs 
with a distinct idea of the reason for their employment that the 
writer has endeavored to bring together in a readable form the com- 
bined results of laboratory and bedside experience, thinking the time 
ripe for such a task. It is true that several other books give, in a 
more or less thorough manner, a resume of the physiological action 
of the drugs of which they treat, but in even the best of them only 
the most trained student of pharmacology can discover the close rela- 
tionships which exist between the results reached by the physiologist 
on the one hand and the clinician on the other. The two parts of the 
study are usually so divorced by the prolonged mental effort neces- 
sitated by the arrangement of the text that the student either ignores 
the physiological action for the sections on therapeutics, or crams the 
former to pass an examination required by the teacher whose course 
he must follow. As a consequence, too many physicians regard 
pharmacology simply as a species of mental training, or believe it to 
be a waste of time and energy. No one can think that the writer of 
this book will ever deny the value of original research or bedside 
experience, but he does desire to weave science and practice into so 
close a network that the foundations of experience may be cemented 
by the mortar of exact knowledge. In some instances, however, 
science and practice seem to be absolutely opposed, and only future 
research can explain the apparent contradiction 

Throughout this book, in every part where drugs or diseases are 
considered, the writer has arranged the titles in alphabetical order, 
according to their English names. This has been done because it is 
desired to afford the reader a ready-reference book to which he may 
turn at short notice for desired information, for at present the state 
of pharmacology is so unsettled that a true classification is impossible. 
Thus, morphine may be classed by one writer as a nervous sedative, 
by another as a sleep-producer, by a third as a bitter substance, and 
by a fourth as a respiratory depressant. Bromide of potassium can 



10 PREFACE TO THE FIRST EDITION. 

with equal propriety be called a spinal sedative or a cerebral seda- 
tive, or caffeine be classed as a cerebral stimulant, a circulatory stim- 
ulant, or a diuretic. 

In order to make the book more complete, the preparations of the 
British Pharmacopoeia have been introduced ; and with the same 
object in view, a dose-list of drugs, both official and unofficial, has 
been appended for ready reference. The subject of medical elec- 
tricity has heretofore commonly found a place in most text-books on 
therapeutics, but has been advisedly omitted in this instance, since 
electrical therapeutics has outgrown any work save one devoted to 
that subject alone. 

For many of the articles on treatment the author wishes to thank 
friends who have earned prominence in connection with their special- 
ties. Thus Dr. G. E. de Schweinitz has contributed the articles on 
the treatment of diseases of the eye ; Dr. Edward Martin, those on 
the treatment of venereal diseases and on antisepsis ; Dr. Barton C. 
Hirst, those on the treatment of diseases of the puerperal state ; and 
Dr. J. Howard Reeves, the articles on the treatment of diseases of 
the upper air-passages. All of these articles enhance the value of 
the book to so great an extent that the author feels sure they will be 
sought out and read with interest. 

In addition to the general index, a copious and explanatory index 
of diseases and remedies has been appended, which will prove sug- 
gestive and valuable to practitioners, and for which the author is 
indebted to his friend and student, Mr. J. G. Clark. 

Philadelphia, 222 South Fifteenth Street. 
Sept., 1890. 



CONTENTS 



PART I. 

PAGE 

General Therapeutical Considerations . 17 



PART II. 

Drugs 39 

PART III. 

Remedial Measures other than Drugs 359 

Foods for the Sick 406 

PART IV. 

Diseases 413 

Table of Doses of Medicines 665 

Tables of Relative Weights and Measures in the Metric 

and Apothecaries' Systems 681 

Index of Drugs and Remedial Measures 683 

Index of Diseases and Remedies 701 



U 



PART I. 
GENERAL THERAPEUTICAL CONSIDERATIONS. 



Before entering into a study of the action of drugs upon a living 
body, it is necessary that the student should possess a clear idea of 
what the word 4i therapeutics " means, the reason why we resort to 
drugs, and, more important than all, that he should grasp the limita- 
tions which govern the administration of remedies. 

Two very foolish and unfounded ideas have recently been put for- 
ward by certain physicians — one being, that medical therapeutics is 
useless ; and the other, that this branch of medical knowledge is not 
advancing with so great a stride as is pathology or surgery. The 
individuals who laugh at the general use of drugs in disease belong 
to one of two classes : either they have never tried them, or if so have 
used the drugs ignorantly or wrongly, or else they believe that they 
are promulgating a new theory, and do not know that the eras of 
excessive dosage and of nihilism are alike relics of the past. No 
reform has ever attacked a crying evil without becoming excessive 
and absurd itself, and if successful in accomplishing its object has 
generally resulted not in the mere remedy of the faults it antago- 
nized, but in so complete a reversal of popular opinion as to force its 
converts into ways as reprehensible as their former habits. Thus, in 
exactly the same manner that the excesses of Catholicism resulted in 
fanatical Puritanism, so did the careless methods of physicians during 
the past century lay the foundation for the growth of homoeopathy or 
therapeutic nihilism. At the present time, although we have much to 
learn, it can be said that we have benefited by both of these errors, 
and are in consequence taking a path which may be considered the 
happy medium. 

To the majority of the readers of this book, however, the harmful- 
ness of over-dosing is sufficiently evident, and the cry of " no drugs 
at all " so absurd that no rebuttal need be offered. 

The statement that therapeutics is to-day more backward than are 
pathology and surgery is readily answered by a denial ; for the thera- 
peutist is able to treat successfully many diseases of which the pathol- 
ogist knows nothing, and is obliged to rest his treatment on empiri- 
cism simply because he cannot tell how his drugs act if the pathologist 
cannot tell him what the disease is. Rheumatism is a good example 
of this very point. 

2 17 



18 GENERAL THERAPEUTICAL CONSIDERATIONS. 

In regard to surgery, every one must recognize the extraordinary 
advances made in this branch of medical science, yet comparatively 
few realize that it is solely by the introduction of drugs that all its 
triumphs are posssble. The definition of the word " therapeutics " in 
Billings's Dictionary is: " That branch of medical science which treats 
of the application of remedies to the cure or alleviation of disease," 
and, practically, the term is almost universally used to signify the 
employment of drugs for such purposes. The credit for the intro- 
duction of new instruments may or may not be accorded to surgery, 
but the discovery of new drugs must be accorded to therapeutics. We 
find, then, that ether and chloroform began to revolutionize surgery 
fifty years ago, and that corrosive sublimate, carbolic acid, and other 
drugs have revolutionized it once more within the lifetime of every 
one who reads this book. Cocaine has changed the entire aspect of 
eye surgery and other minor operations, and has immediately averted 
an enormous amount of pain and suffering which the surgeon could 
not relieve, and certainly could not remove, in the absence of its 
influence. To the accusation of backwardness the therapeutist can 
well reply by asking the champion of any other branch of medical 
science to put forward one discovery which equals antipyrine or ace- 
tanilide in pow r er to relieve disease or pain, or which can be applied 
as specifics to so wide a scope of ailments. 

In the language of one of the most progressive medical men of 
to-day in the United States, the man who does not believe in the 
proper use of drugs for the cure of disease must lack the very key- 
stone of the arch upon which all medical knowledge rests. 

The ultimate aim and object of all medical thought and effort is 
the cure or alleviation of disease, and therapeutics is the refined 
product culled from every department of medical learning. Like 
every other thing requiring a thorough knowledge of its component 
parts, it is often much abused by the careless and ignorant, but is 
a power for good in the trained hand of the properly educated 
physician. 

Further than this, therapeutics is the only universally used branch 
of medicine, for each and every branch must resort to it, and the 
most skilful operator who fails to treat his cases medicinally with 
equal skill will have worse results than he who, though bungling in 
his surgery, yet uses drugs intelligently after his slashing is finished. 

Homoeopathy depends upon more than one reason for its exist- 
ence. If infinitesimal doses are given, the patient is satisfied that 
he is receiving medicine, and Nature often produces her most rapid 
cures when left alone. Again, the entire basis of homoeopathic thera- 
peutics rests not upon the study of the causes of diseases, but upon 
the symptoms which constantly present themselves. As a result of 
this, so many minor symptoms are relieved that the patient's comfort 
is ensured, and doubtless in many instances serious disorders are dis- 
covered which might otherwise be cast aside or go unseen. No detail 
should be too small to attract the attention of the physician, and he 
who exercises care in detail must reap reward in larger measure. 



MODES OF ADMINISTERING DRUGS. 



MODES OF ACTION OP DRUGS. 

Drugs act in two ways, which are sometimes called near and 
remote, direct and indirect. The near, or direct, action of a drug is 
that influence which is felt by the exercise of its effects directly upon 
the tissues with which it comes in contact ; the indirect, or remote, 
influence is that result which comes as a sequence of its primary 
effect. As an illustration of this we may take the local use of can- 
tharides. The local, near, or direct effect of this is a blister ; the 
remote or indirect effect is the absorption of exudations or the influ- 
encing of inflammatory processes. If pilocarpine is used, its direct 
effect is the sweating which ensues, while its indirect effect is the 
relief of dropsy through the removal of exudation by the increased 
action of the skin, salivary glands, and kidneys. 



MODES OF ADMINISTERING DRUGS. 

Drugs may be administered for the purpose of affecting the gen- 
eral system in many ways, but practically we employ only six 
methods, as follows : 

1. By the mouth or stomach ; 

2. By hypodermic injection ; 

3. By inhalation ; 

4. By the rectum ; 

5. By inunction ; 

6. By the endermic method. 

By far the most usual manner of administering drugs is by way 
of the mouth, which is the most natural means of entrance into the 
body for foreign substances. Whenever medicines are used in this 
way, the physician should clearly bear in mind what the medicine is 
to do after it is swallowed. Thus, if the drug is intended to act 
directly upon the stomach, it should not be given after meals, but 
some time before, since the food and gastric juice may afterward so 
cover the gastric mucous membrane that the medicament cannot act. 
Thus, in the case of chronic gastric catarrh or gastric ulcer, the 
nitrate of silver which is used should always be given half an hour 
or an hour before meals. On the other hand, if an ulcer or other 
trouble exist in the small intestine, the pill should be given some time 
after meals, and, if a heavy meal is taken, three or four hours after, 
since under these circumstances the medicine is swept out into the 
intestine almost at once, without remaining any time in the stomach, 
where it may be chemically altered. Very often it is necessary to 
give a medicine soon after food is taken, in order that it may not 
act in too powerful or concentrated a manner upon the viscus which 
receives it. 

The general rule, however, may be laid down that all medicines 
are to be taken after rather than before meals, unless a local gastric 
effect or very rapid absorption is desired. 



20 GENERAL THERAPEUTICAL CONSIDERATIONS. 

Next to the use of drugs by the mouth, by far the most popular 
method is their administration by means of the hypodermic needle and 
syringe. The logic of this method rests upon the absorption of all 
soluble substances from the subcutaneous tissues with great rapidity. 
Any substance soluble enough or suspendable enough to pass through 
a hypodermic needle without forming an obstruction may be employed, 
provided it is not too irritating and that it is " clean." 

The proper places to give such injections are the forearm on the 
extensor surface, 1 the calf of the leg, the buttock, or the broad of the 
back — in other words, any spot where the tissues are not dense and 
unyielding. The skin of the part is to be grasped or pinched up 
with the thumb and forefinger of the left hand and the needle sent 
well into this raised fold, preferably above the finger and thumb, so 
that the pressure of the fingers may prevent pain and the too rapid 
entrance of the medicine into the system. The needle should always 
penetrate well into the loose connective tissue, so that the liquid 
injected may find lodgment in the loose and spongy subcutaneous 
tissues without separating the skin from its rather close adhesion to 
the tissues below or from the blood-vessels supplying it, for if sepa- 
ration occurs abscess and a slough may result. 

The dangers from hypodermic injections are chiefly two. First: 
The medicine may enter a vein, owing to the penetration of its wall 
by the needle, and the entire dose be carried at once, en masse, to 
the vital centres. Second : The solution used may not be sterile or 
the needle may be dirty, and an abscess may result. The first dan- 
ger is to be avoided by injecting into spots not well supplied with 
veins, and the second by thoroughly washing both syringe and needle 
with water the instant before they are used, pushing a fine wire 
through the needle, and in some cases by soaking the latter in car- 
bolized oil. The liquid injected may be rendered sterile by using 
freshly boiled water and adding thereto carbolic acid in such propor- 
tion that one-half to one drop of carbolic acid is present in each 
injection. It is claimed by some that this use of carbolic acid 
seriously hinders absorption, and in cases of urgency it should 
not be used. Most hypodermic syringes hold from twenty to thirty 
minims. 

When drugs are given by the rectum, we employ them for three 
purposes : First, to influence the general system by their absorption ; 
secondly, to act locally upon any disease which may be present in this 
particular locality or in the colon ; and, finally, to dislodge substances 
or parasites which it is desired to bring away. The word "enema" 
is loosely used to denote all these injections, be their purpose what 
they may, and is synonymous with " rectal injection" or the more 
old-fashioned word "clyster." If nourishment is being given, the 
injection is called a "nutrient enema." Sometimes these injections 
are called "lavements." 

In this mode of administration it is very necessary that the physi- 

1 Hypodermic injections into the anterior aspect of the forearm often cause much 
pain in the hand by irritating temporarily the branches of the radial or ulnar nerves. 



MODES OF ADMINISTERING DRUGS. 21 

cian should use his medicaments in proper bulk ; and it may be laid 
down as a rule that no more liquid should be injected than is neces- 
sary to convey the medicine or food, unless the injection is for the 
purpose of emptying the bowel of faecal matter or other materials, or 
it be desired to distend the bowel in order to overcome obstruction, or 
to influence the colon by drugs, 

The reason for this lies in the fact that any large bulk of liquid 
sent into the rectum so stimulates its walls by distention as to cause 
spasmodic contraction, with expulsion of all the rectal contents, which 
is just what is needed when fecal matter is to be removed, but the 
opposite of what is desired when retention of a remedy or food is 
necessary for absorption or local action. In rectal catarrh or ulcer 
tw T o to four ounces of liquid are usually sufficient in an adult to 
accomplish any medicinal influence locally or by absorption, while as 
a laxative enema one to two pints may be employed. 

In the use of injections we frequently find that the rectum becomes 
irritable, and promptly resists all efforts to force the entrance of 
liquids or solids. This is to be avoided by giving the injection so 
gently that the bowel fails to recognize, as it were, the entrance of 
liquid, and by introducing a few drops of oil and laudanum in each 
injection. 

A large amount of distress often follows the gradual accumu- 
lation of faecal masses in the colon which are not passed with 
the daily movement of the lower bowel. These can readily be 
removed by large injections of warm water or by the use of medi- 
cated liquids. 

A very important use of injections by the rectum is in the treat- 
ment of the various causes of intestinal obstruction. Here the great- 
est caution should be exercised that the injection be made with all 
possible gentleness, and slowly, the liquid being allowed to dribble 
into the bowel rather than to force its way. It is dangerous to use a 
greater pressure than is given by a fountain syringe at the height of 
two or three feet, as rupture of the peritoneal coat of the bowel may 
occur. Where a large quantity of water is used it should be care- 
fully warmed to 100° or a little more, and it is well to add salt to it, 
so that it will represent the normal saline strength of blood-serum, 
namely, seven-tenths of one per cent. (For use of injections in 
special diseases see Part IV., and for Enteroclysis, Part III.) 

Suppositories are another means by which we introduce medicines 
into the bowel, either for local effect or to act after absorption of 
their contents upon the general system. 

When drugs are given by inhalation they are generally employed 
with the object of affecting the respiratory tract alone, although there 
are notable exceptions to this in ether, chloroform, nitrous oxide gas, 
and other volatile substances. Aside from anaesthetics, we find such 
remedial measures adopted as the inhaling of steam laden with the 
drugs employed, the respiring of air loaded with the fumes of the 
medicament, or the inhalation of gases, and last, and most commonly 
resorted to of all, the use of the atomizing spray, which, if properly 



22 GENERAL THERAPEUTICAL CONSIDERATIONS. 

made and employed, so minutely divides the liquid containing the 
medicine that the inspired air carries it to the farthest bronchiole 
and pulmonary vesicle. 

As an example of the rules governing the administratien of drugs in 
this manner we find that compound tincture of benzoin may be taken 
by inhaling the steam arising from hot water containing it, but can- 
not be used in a spray because it occludes the fine points of the atom- 
izing tubes. In a similar manner we may inhale the smoke of bella- 
donna or tobacco-leaves to relieve asthma, or the fumes of chloride 
of ammonium for bronchitis in its later stages. Finally, we find that 
oxygen is sometimes very useful, the gas being readily inhaled, with 
good results in proper cases. 

The " spray " or atomizer is made in two forms — one form of appa- 
ratus being worked through the agency of compressed air, the other 
through the escape of steam from a small boiler. Very few of the 
compressed-air atomizers throw a spray fine enough to reach the 
deeper parts of the lung, particularly if the air is compressed by 
the hand. 

The inhalation of moist air is very useful in bronchitis, and 
greatly aids other remedial measures. Steam may be disengaged in 
a room by means of a kettle of boiling water or by placing pieces 
of unslaked lime in a pan of water. 

Inunctions consist in the rubbing into the skin of medicines gen- 
erally of an oily or fatty nature, or which assume this character 
through embodiment with oil or fat. The three substances most com- 
monly used in this way are cod-liver oil, mercurial ointment, and 
iodine ointment. They should always be applied on some part where 
the derm is thin and well supplied with subcutaneous. lymphatics, as 
in the axillae, the groins, or the insides of the thighs. Other sub- 
stances have been and may be used by inunction : but as this method 
is necessarily a disagreeable and dirty one, it is rarely resorted to 
unless the stomach is disordered or it is necessary to push the drug 
into the system by every possible avenue of entrance. 

The endermic method consists in the use of a blister, by means of 
which the epiderm is raised, when a little morphine or other alkaloid 
may be slipped under it and so absorbed through the true skin. It 
is a painful method, almost never to be resorted to, which has been 
entirely supplanted by the hypodermic method of medication. 

Remedies are administered in a number of forms, but chiefly as 
follows : 

Abstracts are dry powdered extracts mixed with sugar of milk 
until they are twice as strong as the crude drug. Abstracts are no 
longer official in the United States Pharmacopoeia. 

Aceta, or vinegars, are solutions of drugs in vinegar or acetic 
acid. There are two in the United States Pharmacopoeia (Acetum 
Opii and Acetum Scillae) and three in the British. 

Alkaloids are organic bases, generally occurring in crystalline 



MODES OF ADMINISTERING DRUGS. 23 

form and abstracted from crude drugs. They nearly always repre- 
sent the active principle of the drug. 

Aqu^e, or waters, are used as vehicles either for the dilution of 
strong medicines or for the purpose of carrying minute amounts of 
flavoring materials. 

Cataplasms are not official in the United States Pharmacopoeia, 
but are in the British Pharmacopoeia. They are virtually poultices 
made of linseed-meal or of bread-crumbs. 

Cerates are ointments containing wax to render them harder than 
would ordinary fats. 

Charts, or papers, consist of bibulous paper soaked in a solution 
of the drug which they are meant to carry. 

Confections are sometimes called electuaries or conserves, and are 
soft pastes which contain the drug mixed with sugar or honey. 

Decoctions are solutions of drugs made by boiling and then strain- 
ing while hot. 

Elixirs are diluted tinctures rendered pleasant to the taste by the 
addition of aromatic substances and sugar. 

Emplastra, or plasters, are made up of adhesive substances placed 
upon a backing of cloth or leather and designed to adhere to the skin, 
being so applied for the purpose of holding a medicinal substance in 
contact with the body, of acting as a protective, or of aiding in the 
approximation of the edges of a wound. 

Extracts consist of the soluble parts of plants reduced to a semi- 
solid or solid condition by evaporation ; the soluble constituents being 
taken from the plant by water or alcohol. 

Fluid Extracts are made in the same way as solid extracts, except 
that they are not so completely evaporated. 

Glycerita, or glycerins, are solutions of various substances in 
glycerin — the glycerin being used as a vehicle. 

Infusions are made by pouring boiling water on the crude drug 
and allowing it to stand for a short time until the water cools, after 
which the liquid is strained. Sometimes cold water is employed. 

Pills are small round masses which, as a general rule, should not 
weigh more than three grains, in order to avoid their being too bulky. 
If the material is a heavy one, as much as five grains may be placed 
in each pill. Pills may be uncovered or coated with sugar or gelatin. 
If the pill is fresh and the sugar pure, they are useful. Many pills 
are fraudulently coated with varnish and are insoluble. 

Suppositories are small masses made into a cone shape and 
having for their basis cacao butter. They are designed to carry into 
the rectum certain medicines for absorption into the system or for local 
action. 

Tablets. — Under this name manufacturing pharmacists and others 
prepare compressed pills or lozenges, generally of small size, the mass 
being made to adhere by means of its being subjected to great pres- 
sure by special machinery. Smaller tablets are used for carrying 
powerful drugs for hypodermic use. These, however, are often only 
lightly pressed, so as to render them easily soluble. 

Tinctures are solutions of the active principles of drugs in alcohol. 



24 GENERAL THERAPEUTICAL CONSIDERATIONS. 

Triturates are made by adding 10 per cent, of the active medi- 
cine to 90 per cent, of milk-sugar. These are then carefully rubbed 
together until the two are intimately mixed, and are very valuable in 
the administration of medicines to adults or to children. 

Troches, or lozenges, are flat, hardened masses designed for hold- 
ing medicines in the mouth, so that they may be slowly dissolved, 
thereby affecting the local mucous membrane 

Ointments, or unguents, consist of the mixture of some kind of 
fatty substance with the medicine which they are designed to carry. 

Wines are made in the same way as tinctures — strong white wine 
being used in the United States, and sherry or orange wine in Great 
Britain, in place of ordinary alcohol. 



DOSAGE. 

There is, unfortunately, no absolutely fixed rule which can be 
applied to dosage, for several reasons. In the first place, the indi- 
vidual may not be readily affected by drugs, or the disease-process 
which is present may so antagonize them as to render very large doses 
necessary. Further than this, the age and sex of a patient have much 
to do with the regulation of the proper amount of a drug which we 
may give. Finally, that curious but common condition of suscep- 
tibility to various remedies, that we call idiosyncrasy, creeps in as an 
important factor in the decision as to the dose which should be given 
in each case. By far the nearest approach which we can make to 
absolute accuracy in dosage is to use drugs according to the weight of 
the patient, but this method possesses the disadvantages that we can- 
not always weigh our patients, and that the presence of a large amount 
of fat or of dropsy will make an unknown quantity in our calculation 
as to the true weight of the active part of the individual. 

At present we are accustomed to be governed by a list of doses to 
be given to all adults within certain limitations, and which are varied 
sufficiently to permit of great differences in the effects obtained. It 
is in this very point that the success of many a physician chiefly 
rests; for the use of a dose by " rule of thumb " is as empirical and 
lacking in thought as is use of a remedy, not because we have a defi- 
nite action for it to carry out, but because it did some one else good 
who was suffering from what appears to have been a similar attack. 
The dose must be varied to fit the case in the same manner that the 
cut of a coat must be varied to fit each individual. 

There are a number of approximate rules in regard to the doses 
which are to be given in treating the diseases of children, the best of 
which is Young's rule. This is as follows : 

Add 12 to the age and divide by the age. Thus, if a child is two 
years old, we have the following formula : 2 + 12 = 14 -*- 2 = 7, or, 
one-seventh of the dose for an adult is the dose for a child of two 
years. This rule is not a law, however, for of narcotics children 
receive less than this (one-half), and of purgatives or laxatives more 
than this (two or three times). 



IDIOSYNCRASY. 25 

When drugs are given hypoderruically the dose should be generally 
one-half to one-quarter of that given by the mouth, and if any thought 
of idiosyncrasy exist the dose should be smaller still at the start if 
powerful remedies are to be used. 

By the rectum the dose should be twice the amount given by the 
mouth, unless the drug be very powerful or capable of very rapid 
absorption. 

IDIOSYNCRASY. 

This is one of the most interesting features of the study of the 
action of drugs. It is a frequent cause of disappointment to both 
patient and doctor, and an equally frequent cause of excessive action 
from what the physician has thought to be a moderate dose. No rule 
can be laid down for the discovery of idiosyncrasy in a given case, 
except that females, particularly of the hysterical type, are more 
subject to it than are males, although certain men often present marked 
evidences of this tendency. No better illustration of idiosyncrasy can 
be adduced than the case which here follows, nor than that of a friend 
of the author who cannot eat a strawberry without suffering from a 
violent attack of hives. 

The first case is that of a woman of thirty years, suffering from 
severe headache, who received an eighth of a grain of the hydro- 
chlorate of pilocarpine, hypodermically, every twenty minutes, until 
nearly three-fourths of a grain was taken, without any evidence of its 
action either in salivary flow or sweat. But the tolerance of drugs 
did not stop here. Twenty drops of tincture of cannabis indica every 
four hours failing to relieve the pain, half-grain pills of the solid 
extract were ordered, two of which commonly affect a grown man 
most markedly. The extract had been proved to be active to other 
patients, In order to avoid any failure in absorption the pills were 
each cut in half before they were given, and forthwith administered, 
one every three hours, without any effect after ten had been taken. 
Twenty more of the pills from the same manufacturers, but from a 
different retailer, were now given, one every hour with the exception 
of a few irregularities in administration during the night, the entire 
twenty being swallowed between four o'clock one afternoon and two 
o'clock in the next afternoon. The thirty pills (fifteen grains) were 
taken in less than forty-eight hours without producing a single physio- 
logical sign of the slightest character. That the doses were really 
swallowed would seem to be undoubted, for their administration was 
carried out by a trained attendant, and their black color forbade their 
expulsion from the mouth on the bed without attracting attention. 
The hypodermic injections were given by the author, and, as the solu- 
tion was used as fast as it was made, the patient must certainly have 
received all of the pilocarpine. 

As there was daily an afternoon rise of temperature amounting to 
several degrees, quinine bisulphate was ordered in the dose of fifteen 
grains, to be given after six powders of one-sixth of a grain of calomel 
had been taken ; this not only failed to control the fever, but also 



26 GENERAL THERAPEUTICAL CONSIDERATIONS. 

produced no buzzing in the ears. The writer was now inclined to 
consider all the symptoms as hysterical, even including the evening 
rise of temperature. 

Twenty-four hours after the last dose of cannabis indica the attend- 
ant gave the patient, without orders, no less than sixty grains of anti- 
pyrine in sixteen hours without any physiological symptoms, and, under 
orders, she took from forty to fifty grains of bisulphate of quinine every 
day for three days without any signs of cinchonism. 

Wide experience has taught us, however, that several conditions 
act fairly constantly in regard to some idiosyncrasies. Certain dis- 
eased conditions — such as peritonitis or pain — allow large doses of 
opium to be given, and in lead-poisoning and paralysis patients may 
require enormous doses of active purgatives to move the bowels. 

The climate in which the patient lives, or has been accustomed to 
live, renders him more or less susceptible to certain remedies. Thus 
the East Indian runs amuck after eating hasheesh or cannabis indica, 
or the Chinaman goes into a delightful dreamland from smoking 
opium, whereas the Anglo-Saxon experiences no such agreeable sen- 
sations, as a general rule. Southerners generally require larger 
doses of purgatives than Northerners, often because their livers are 
not as active. 

The temperament of an individual is also a highly important matter 
to be considered. It is a notorious fact that phlegmatic dark-skinned 
persons , usually yield to drugs less readily than blonds and nervous 
persons, more especially in respect to the drugs which act on the ner- 
vous system. Nervous light-haired women stand belladonna very 
badly as a general rule, while children Avill take large doses often 
without discomfort. Opium is usually badly borne by children. 

Habit is another important factor governing idiosyncrasy. We all 
know how rapidly one becomes accustomed to tobacco, and how mor- 
phine habitues take enormous amounts of their favorite drug without 
effect. 

ABSORPTION OP DRUGS. 

The knowledge of the rapidity with which certain drugs are absorbed 
from the various surfaces with which they come in contact is of 
importance in order that we may know when to repeat the dose if 
the first amount does not produce the desired effect. The rapidity 
of absorption depends upon a number of factors. If the circulation 
is active, absorption is active, but if it be depressed, absorption is slow. 
Thus, in a person apparently drowned, absorption may not occur at 
all until the vital functions are restored, and repeated doses given to 
the patient while unconscious, acting together, in the end poison him. 
This is often the case in delirium tremens where hypodermic injec- 
tions of morphine are given or when the drug is administered by 
the mouth. In dropsy absorption is peculiarly slow, and the drug 
may remain in the tissues for days, only to be absorbed with the exu- 
dation after severe purgation or profuse diuresis, or tapping. In 



STRENGTH AND RELIABILITY OF DRUGS. 27 

general dropsies hypodermic medication is nearly always worse than 
useless. 

When the stomach or bowel is empty absorption from either is 
rapid, but when they are full it is very slow. In this fact we find the 
reason for the popular idea that a glass of whiskey when a man is 
hungry makes him drunk, whereas twice the quantity after dinner 
does not do so. 

Drugs in the stomach or bowel have no influence over the general 
system unless they are irritants. They only act when taken into the 
blood or lymphatics. 

Recent studies show that alcoholic solutions of drugs are more 
rapidly absorbed than are watery solutions or those made with gly- 
cerin or milk. 



DURATION OP ACTION OF DRUGS. 

The duration of the action of drugs depends partly upon their 
rapidity of absorption, but chiefly upon the rapidity or slowness of 
their destruction in the body or their elimination from it. Thus, 
volatile substances, such as ether, chloroform, and nitrite of amyl, act 
only for a short time and are quickly eliminated, whereas bromide of 
potassium and digitalis continue active during many hours, and are 
slowly eliminated, as in the case of the former, or oxidized, as in that 
of the latter. Again, if curare is given hypodermically it will cause 
paralysis, but if taken by the stomach in moderate amount it will be 
eliminated by the kidneys as rapidiy as it is absorbed, and produce 
no effects if these organs are active. 

From studying the rapidity of the elimination of a drug we learn 
how often to order a dose. Thus, digitalis may be given once, twice, 
or thrice a day, but carbonate of ammonium every two or three hours. 

When the physician is not careful in the use of a drug which is 
eliminated slowly, it may suddenly develop so severe an effect as to 
cause alarm, owing to the accumulation of the poison in the body. 
This is called "cumulative action." 



STRENGTH AND RELIABILITY OP DRUGS. 

If a census could be made of those who die annually from the use 
of drugs which are impure or useless from weakness, the writer 
believes that a most alarming array of figures would be presented. 
For many years this was unavoidable to a great degree, either because 
our knowledge of the active principles of drugs and the methods of 
isolating them was deficient, or because the time consumed in their 
transportation by sailing vessels or on the backs of natives from the 
countries in which the natural products yielding the drugs were 
obtained, permitted deterioration to take place. At present these 
difficulties have been largely overcome. The trained pharmacist is 
taught how to make an essay for active principles in most of the valu- 
able alkaloidal drugs, and every physician should make careful inves- 



28 GENERAL THERAPEUTICAL CONSIDERATIONS. 

tigation into the quality of all preparations which he employs. That 
these remarks are not out of place will be seen by the fact that very 
recently an intimate friend of the writer bought from five of the lead- 
ing druggists of Philadelphia six ounces of tincture of nux vomica 
which were stated to have been made according to the directions of 
the United States Pharmacopoeia. That made by perhaps the leading 
druggist of the five contained twice as much strychnine and brucine 
as it should, and had twice as much solid residue ; or, in other words, 
a physician prescribing this tincture in full dose would probably have 
poisoned his patient and reported the case as one of unusual suscepti- 
bility to drugs ! On the other hand, the author has recently seen a 
tincture of nux vomica which contained only a trace of alkaloid, but 
had much inert solid residue. In neither instance was the druggist 
a dishonest one intentionally, but one had used a crude drug which 
was unusually rich in alkaloids, while the other had purchased nux 
vomica beans which, by reason of immaturity, bad surroundings, or 
exposure to weather, were very poor in active principles. All these 
disadvantages may be avoided if physicians will insist that the drug- 
gists who dispense the drugs they order shall either themselves pre- 
pare assayed products, or purchase such products from any one of the 
large manufacturing chemists who put assayed goods on the market. 
When this is impossible, the physician should employ the alkaloids 
in pill form, or, if solutions are desirable, the alkaloid may be added 
to alcohol and water and given by drops, as is the case with any ordi- 
nary tincture. Digitalis and veratrum viride are practically the only 
drugs with which this cannot be done ; in the first the action of the 
drug does not depend upon a single active principle, but upon a large 
number, and in the second the relative proportions of jervine and 
veratroidine cannot be well estimated by the physician. H. C. Wood 
records a case in which opium poisoning occurred in a child who had 
taken a Dover's powder ; the reason being that the amount of opium 
intended for many doses was in the powder that was dispensed, the 
other constituents not having been properly mixed with the opiate in 
compounding the prescription. Constant uncertainty is a dangerous 
element when we are dealing with patients who are desperately ill ; 
and in many cases failure and discouragement may both be avoided 
if the physician will see to it that the tools with which he works are 
in good order and capable of doing what he requires of them. A 
poor drug to the physician is w T orse than a rusty knife to the surgeon ; 
for the injury in the one case is unknown, whilst in the other it can 
be carefully watched and guarded. 



INDICATIONS AND CONTRAINDICATIONS AND 
DEFINITIONS. 

The indication for a drug is any symptom or series of symptoms 
which we know the drug will relieve without causing at the same 
time an evil effect to be felt by other parts of the body. A contra- 
indication is any coexisting state or tendency which will be made so 



INDICATIONS, CONTRAINDICATIONS, AND DEFINITIONS. 29 

much worse by the drug as to forbid its use. Thus, one might be 
tempted to give quinine in meningitis for the fever, yet this would 
be bad therapeutics, since quinine is contraindicated because it will 
intensify the meningitis. 

Abortifacients form a class of drugs which, as such, ought never 
to be employed. If pregnancy is to be interrupted, the interruption 
should be produced by instrumental means, and then only after 
consultation. 

Alteratives are indicated where cell-growth is active to excess, but 
contraindicated where tissue break-down is present, or there exists a 
tendency thereto. 

Anaesthetics are drugs used to produce lack of sensation. They 
are either local or general. Many of the local anaesthetics produce 
loss of sensation through benumbing the parts by the cold they pro- 
duce. Cocaine is an example of a local anaesthetic which causes 
anaesthesia by a direct paralyzant action on the peripheral sensory 
nerves. 

Anaphrodisiacs are remedies used to diminish sexual desire. 

Antacids are employed in cases of gastric fermentation when, as 
a result of the morbid processes, lactic and butyric acids, or even 
hydrochloric acid, are found in abnormal quantities. 

Anthelmintics are those remedies which are used for the purpose 
of removing intestinal worms. 

Antiarthritics is the name given those drugs which are employed 
for the purpose of relieving inflammations occurring in joints, whether 
these be in an acute or chronic condition of disease. Colchicum, 
which is one of this classs, is contraindicated, as a rule, in cases of 
gouty inflammations of the joints if the bowels are already moving 
too freely, as, under these circumstances, retrocedent gout is apt to 
occur. 

Antihydrotics are used to prevent excessive sweating, either when 
it is local or general. Camphoric acid is probably the best general 
antihydrotic. 

Antiperiodics is a term applied to drugs or remedies employed for 
the prevention or cure of malarial poisoning. They are so named 
because they tend to break up the periodicity of the attacks, which 
periodicity is a characteristic of such diseases. 

Antiphlogistics are remedies employed to prevent the progress of 
inflammatory processes. They are nearly all contraindicated in the 
presence of tissues possessing an impaired vitality through previous 
conditions of disease. 

Aphrodisiacs are remedies used to increase sexual desire and 
power. 

Astringents are employed for the purpose of contracting or con- 
stringing tissues. They act not by coagulation of albumin, but by 
their influence over the vital processes of the tissues with which they 
come in contact. Theoretically, all astringents should be non-irri- 
tating, but practically they possess irritant properties, and are, in 
consequence, contraindicated in the presence of very acute inflamma- 
tions, as a rule. Three of the mineral astringents, however, possess 



30 GENERAL THERAPEUTICAL CONSIDERATIONS. 

marked sedative properties in addition to their astringent power, and 
can therefore be used freely in acute inflammations when locally 
applied. They are nitrate of silver, subacetate or acetate of lead, 
and the subcarbonate or subnitrate of bismuth. 

Bitters are remedies designed to increase the activity of the 
mucous membrane of the gastro-intestinal canal by increasing its 
tone. They may be divided into simple bitters and complex bitters. 
The first depend upon their bitterness solely for their activity ; the 
second class is well represented by quinine or strychnine, both of 
which are exceedingly bitter, but, in addition to their local eifect on 
the gastro-intestinal mucous membrane, act as stimulants to other por- 
tions of the organism. A good example of a simple bitter is columbo. 
Many bitters contain so much tannic acid that they are not generally 
useful, and for this reason very few can be used with preparations of 
iron, since a tannate of iron would be formed. 

Cardiac sedatives are drugs which decrease the force of the heart, 
and, as a class, the amount of blood expelled at each beat of the ven- 
tricles. They are indicated in arterial excitement, contraindicated 
in arterial depression. 

Cardiac stimulayits are drugs which increase the force of the heart, 
thereby increasing the quantity of blood expelled from the ventricles. 
This may be accomplished by an increase in the rapidity of the beats 
or by a greater output of blood at each contraction, the diastole being 
sufficiently prolonged to admit of the ventricles being well filled. 
They are contraindicated in the presence of arterial excitement, and 
indicated in arterial depression. 

Carminatives are remedies given for the purpose of expelling flatus, 
particularly if there is reason to believe that the " wind " has accu- 
mulated because of intestinal torpidity. Many of the carminatives 
are necessarily possessed of irritant properties, and are therefore con- 
traindicated in the presence of flatulence due to intestinal atony aris- 
ing from inflammation. The best carminative is spiritus aetheris com- 
positus, or Hoffmann's Anodyne. 

Cathartics. — These are drugs employed when a positive and 
decided action of the bowels is desired. They occupy a position 
between the purges and the drastics. (See Purges and Drastics.) 
The best example of a cathartic is probably jalap. 

Cholagogues are used when it is desired to exert a stimulant influ- 
ence over the flow of bile, without necessarily increasing intestinal 
peristalsis. Nitro-hydrochloric acid is, perhaps, the best type of a 
pure cholagogue, while podophyllum represents the class of chola- 
gogues which increase intestinal peristalsis in addition. Cholagogues 
are contraindicated in the presence of acute inflammation of the gall- 
bladder or liver. 

Counter-irritants are remedies used to produce irritation at a spot 
distant from a painful or inflamed area, in order to relieve the diseased 
parts by reflex action exerted through the nervous system upon the 
painful nerve or disordered capillary network. 

Demulcents are substances used to protect any exposed parts of 
the body from irritation. 



INDICATIONS, CONTRAINDICATIONS, AND DEFINITIONS. 31 

Diaphoretics produce an increased secretion from the sweat-glands. 
They may be considered as internal and external. The internal are 
represented by pilocarpine, which stimulates the sweat-glands them- 
selves ; the external are represented by the Turkish and Russian 
baths, which, by increasing bodily heat, cause a profuse sweat by 
reflex action. 

Diuretics are used to increase the flow of urine from the kidneys. 
They act by stimulating the renal epithelium to greater activity, 
thereby increasing the excretion of both the watery and solid con- 
stituents of the urine ; or they simply increase the watery constituents 
by increased blood-pressure in the kidney. 

It is to be remembered that the vegetable salts of potassium and 
the lithium salts increase the solids in the urine, not by stimulating 
the secreting epithelium of the kidney, but by uniting with insoluble 
material in the system, forming soluble compounds which are then 
readily eliminated. (See Eliminators.) They are indicated in con- 
ditions of renal inactivity due either to functional or organic causes. 
Irritating diuretics, such as cantharides, for example, are contraindi- 
cated in acute nephritis. Such a diuretic is only to be used where 
the kidneys are inactive through atony or prolonged chronic or sub- 
acute disease. 

Eliminators are drugs which, by forming soluble compounds with 
insoluble substances in the body, render them capable of being ex- 
creted by the excretory organs, such as the skin, kidneys, and bowels. 

Emetics are drugs used to produce vomiting. They act centrally 
when, as is the case with apomorphine, they stimulate the vomiting 
centre, peripherally when they irritate the Avails of the stomach. 
They are indicated when we wish to unload the stomach of unde- 
sirable materials, or when we desire to cause an increased flow of 
bile from the gall-bladder, which is accomplished by the pressure 
exerted upon this viscus when the abdominal walls and diaphragm 
contract in retching. When the ducts are mechanically obstructed 
by a gall-stone emetics are dangerous, as they may cause rupture 
of the gall-bladder. 

Sometimes we are able by the use of emetics to rid the lungs and 
stomach of mucus in bronchitis or gastric catarrh. 

The contraindications to emetics are cerebral congestion or menin- 
gitis, gastritis, gastric ulcer, advanced pregnancy, and hernia. 

Emmenagogues are remedies used to produce or increase the men- 
strual flow. They are of two classes — direct and indirect. The direct 
are all of them irritants, and are seldom of much value ; the indirect 
are used to overcome the morbid condition underlying the menstrual 
disorder, and H,re therefore more rational. Thus iron and arsenic may 
be used in amenorrhoea due to anaemia with beneficial result. 

Expectorants are employed when it is desirable to promote secretion 
or to get rid of secretion in the bronchial tubes. Thus, in the early 
stages of an acute bronchitis the mucous membrane is hypenemic 
and swollen, but dry and irritable. Ipecac and citrate of potassium 
form at this time a sedative expectorant mixture, which, while allay- 
ing irritation, promotes secretion, and so relieves the engorged area. 



32 GENERAL THERAPEUTICAL CONSIDERATIONS. 

On the other hand, after the acute stage is passed, there may be so 
much atony of the mucous glands that the secretion is either too 
scanty or too viscid to be coughed up. Stimulant expectorants, such 
as chloride of ammonium, eucalyptus, and terebene, are now to be 
employed. These latter drugs are contraindicated in the acute inflam- 
matory stage of the disease, as they would simply stimulate the irri- 
tated mucous membrane to greater irritation. 

Hypnotics are drugs used to produce sleep. They may be divided 
into those which produce sleep and relieve pain, and those which have 
no analgesic power. The latter are therefore not to be employed in 
sleeplessness due to pain, and the former are contraindicated when 
pain is absent. Thus, chloral produces sleep if it be ordinary func- 
tional insomnia ; but if the sleeplessness is due to pain, opium is the 
drug to be employed. Chloral, in ordinary doses, is the purest hyp- 
notic that we have. 

Mydriatics are drugs which produce dilatation of the pupil or 
mydriasis. Conditions of the eye associated with increased intra- 
ocular tension are contraindications to mydriatics, as a rule. 

Myotics are drugs which cause contraction of the pupil or myosis. 
They are best represented by eserine. 

Nervous sedatives are indicated and contraindicated in a reverse 
manner to nervous stimulants. 

Nervous stimulants are contraindicated in nervous excitement, indi- 
cated in nervous depression. 

Oxy toxics are drugs which increase the expulsive power of the 
uterine muscular tissues. 

Revulsives are remedies used to produce increased activity of the 
general system or parts thereof through reflex influences — that is, 
they cause a determination of blood to one part, thereby relieving an 
engorged area. Thus, in cerebral congestion or effusion a vigorous 
purgative or cathartic may give relief by exercising a derivative 
effect. Revulsives are closely allied to counter-irritants. 

Roborants are drugs or measures devoted to the repair and build- 
ing up of tissues in the body, and comprise both foods and drugs. 
Roborant treatment also includes hygienic surroundings, fresh air, 
light and healthful employment. 

Tonics are used to increase vital activity. They are indicated in 
instances of local or general systemic depression, contraindicated in 
cases of inflammation or excitation with excessive functional activity. 
(See Bitters.) 

Vasomotor depressants are drugs which decrease arterial pressure 
by an action on the vasomotor nervous system rather than by an 
action on the heart. They act by relaxing the blood-vessels. 

Vasomotor stimulants are drugs which increase arterial pressure 
by an action on the vasomotor system, thereby producing contraction 
of the blood-vessels. 



INCOMPATIBILITY. 33 



COMBINATION OF DRUGS FOR JOINT EFFECT. 

The study of the physiological action of drugs has aided us very 
greatly in improving our therapeutic measures. Thus, we now know 
that chloral is a heart-depressant and cannot be used in very full 
doses, or pushed to produce sleep in persistent insomnia, without 
grave danger ; whereas morphine, which also produces sleep, but does 
not depress the heart, but does depress the respiration, can be com- 
bined with it, and the two acting together, each in small dose, pro- 
duce a heavy sleep, although so little chloral is present that the heart 
is safe, and so small an amount of morphine is used that the respira- 
tion does not suffer. 

Another example of this is found in certain purgative pills where 
the purgative agent is assisted by belladonna and nux vomica, the first 
of which relaxes muscular spasm, while the second acts as a tonic to 
the alimentary tract, the drugs combining to accomplish one result. 

Skill in the combination of drugs, not only for increased physio- 
logical effect, but also for the purpose of making their administration 
pleasant to the taste, has much more to do with professional success 
than is generally supposed. This is particularly so in regard to 
children, for parents dislike forcing their children to take doses 
which they themselves regard as horrible, and they are ever ready to 
believe that as long as a medicine tastes good it is better than one 
which tastes otherwise. 

The medical practitioner who prescribes ever so wisely and appro- 
priately for a patient, but who is utterly regardless as to his combina- 
tions of drugs so far as taste is concerned, will sooner or later see a 
more ignorant man take from him that practice which his greater 
wisdom entitles him to, but which is driven from him by his own 
errors in this matter. 

While in some cases there is no alternative but to give a bad dose, 
in others a little thought and care will often avoid offending the taste 
of the patient. 

INCOMPATIBILITY. 

The chief value of a knowledge of chemistry or pharmacy to a 
practitioner of medicine is the avoidance of what is known as an 
"incompatibility," or the placing in one prescription of two or more 
substances which will undergo chemical interchanges, decompositions, 
precipitations, or cause the formation of explosive mixtures. It is 
impossible to detail all the incompatibilities, and only the most dan- 
gerous and common possibilities of error can be considered : 

1st. An acid should never be combined with an alkali. 

2d. An acid should not be added in any quantity to a tincture. 
The following prescription is an illustration of this : 

R. — Potassii iodidi .^ij- 

Acidi nitro-muriatici i%j- 

Tr. cinchona? comp q. s. f^iij. — M. 

S. — Use as directed : a teaspoonful. 
3 



34 GENERAL THERAPEUTICAL CONSIDERATIONS. 

In this ridiculous mixture the acid is incompatible with the iodide 
of potassium, forming a chloride and setting free iodine, and would 
also change part of the alcohol in the tincture into an ether. 

3d. Alkalies should not be combined with the alkaloids. Thus : 

R. — Strychninae sulph » r -j- 

Potassii iodidi gij. 

Syr. sarsaparillse comp. fgiij . — M. 

S. — Teaspoonful t. d. 

In this prescription the strychnine would be precipitated by the 
potassium salt, and the patient would get nearly all the strychnine in 
the last dose. 

4th. Potassium chlorate should not be ordered to be rubbed up 
with tannic acid or any other organic substance capable of oxidation, 
as it will explode. Permanganate of potassium is subject to the same 
rule. 

5th. Chlorate of potassium and ammonium chloride when mixed 
together may take fire. 

6 th. Iron is incompatible with tannic acid, as it forms a tannate of 
iron, or ink. As all the vegetable astringents contain tannic acid, they 
should none of them be used with iron except chiretta and columbo. 

7th. Tannic acid should never be added to solutions of alkaloids. 

8th. Gum arabic is not to be added to solutions of iron, lead, or 
the mineral acids. 

9th. Alcoholic solutions of camphor and similar resinous substances 
are incompatible with water. 

10th. Fluid extracts are incompatible with water, as the addition 
of water will precipitate them. 

11th. All salts not acid but alkaline in reaction are decomposed 
by acids. 

12th. All salts which are acid are decomposed by alkalies. 

13th. All vegetable acid salts are altered by mineral acids and are 
decomposed by alkalies. 

14th. Iodine and the iodides should not be given with alkaloids. 

15th. Corrosive sublimate, the salts of lead, iodide of potassium, 
and nitrate of silver should always be prescribed alone, except in the 
following instances : 

(a) Corrosive sublimate may be given with potassium iodide, 
since it will throw down a precipitate which redissolves and forms 
a double salt. 

(b) Nitrate of silver may be used with extract of opium or hyos- 
cyamus. 

16th. Syrup of squill should not be given with the carbonate of 
ammonium, as it contains acetic acid. Chloride of ammonium is not 
incompatible with it. 

17th. Cherry-laurel water should not be prescribed with morphine, 
as it may form the poisonous cyanide of morphine. 

18th. Chloral and cyanide of potassium should never be placed in 
the same prescription, as they will decompose each other, setting free 
hydrocyanic acid, 

19th. Cocaine and borax when added together form an insoluble 



CLASSIFICATION OF DRUGS. 



35 



"borate of cocaine. Boric acid and cocaine do not result in this 
formation. 

20th. Calomel and antipyrine are said to be incompatible, as are 
also sweet spirit of nitre and antipyrine. 

21st. Waters cannot be used in preparing saturated solutions of 
drugs, as they are already loaded with a volatile substance. 

22d. Pepsin and pancreatin should not be used together, since 
one destroys the other. 



CLASSIFICATION OP DRUGS. 



In order that the student may gain a definite idea as to the 
various actions of different remedies the following list of drugs is 
appended, which is of necessity somewhat arbitrary. The endeavor 
has been made to place the best or most powerful drug of each class 
first in the list. It is to be remembered that a strict physiological 
classification is impossible. 



II, 



Alteratives. 




Those used against the tape-worm are— 


1. Mercury. 




1. Pelletierine. 


2. The iodides of 


potassium and so- 


2. Aspidium. 


dium. 




3. Pepo. 


3. Iodine. 




4. Pomegranate. 


4. Iodoform. 




5. Brayera. 


5. Iodol. 




6. Kamala. 


6. Arsenic. 




7. Turpentine. 


7. Cod-liver oil. 




8. Chloroform. 


8. Colchicum. 






9. Ichthyol. 




Those used against the seat-worm, or 


10. Taraxacum. 




oxyuris vermicularis, are — 


11. Mezereum. 




1. Quassia. 










2. Turpentine. 


Anaesthetics. 




3. Tannic acid. 


1. Ether. 




4. Chloride of sodium. 


2. Nitrous oxide gas. 


5. Vinegar. 


3. Chloroform. 






4. Cocaine. 




V. Antiseptics. (See also Disinfect- 


5. Bromide of ethyl. 


ants.) 


6. Chloride of ethyl. 


1. Corrosive sublimate in weak so- 


7. Pental. 




lutions. 


8. Bromoform. 




2. Carbolic acid in weak solutions. 

3. Peroxide of hydrogen. 


". Antacids. 




4. Boric acid. 


1. Ammonia. 




5. Sulphate of iron. 


2. Sodium and its 


salts. 


6. Permanganate of potassium. 


3. Liquor potassa 






4. Calcium and it 


= salts 


VI. Antiperiodics or Antimalarials. 



III. 



IV. Anthelmintics. 

Tho.->e that are used against the round- 
worm are — 

1. Santonica 

2. Spi^elia. 

3. Chenopodium. 

4. Azedaraeh. 

5. Santoninate of sodium. 



1. Cinchona. 

2. Eucalyptus. 

3. Warburg's tincture. 

VII. Antipyretics. 

1. Antipyrine. 

2. Acetanilide or antifebrin. 

3. Phenacetine. 

4. Phenocoll. 



36 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



5. Salicvlic acid. 

6. Thallin. 

7. Carbolic acid. 

8. Kairin. 

VIII. Antispasmodics. 



Chloral. 

Bromides. 

Hoffmann's anodyne. 

Camphor. 

Opium. 

Belladonna. 

Asafoetida. 

Musk. 

Valerian. 

Monobromate of camphor. 

Amber. 

Cimicifuga. 

Hops. 



IX. Astringents. 
Vegetable : 

1. Tannic acid. 

2. Hpematoxylon. 

3. Kino. 

4. Catechu. 

5. Bhatany or krameria. 

6. Bhus glabra. 

7. Geranium. 

8. White oak. 

9. Black oak. 

10. Gallic acid. 

11. Bosa centifolia. 

12. Bosa gallica. 

All of these depend chiefly upon tannic 
acid for their active principle. 

Mineral : 

1. Sulphuric acid. 

2. Alum. 

3. Lead. 

4. Nitrate of silver. 

5. Nitric acid. 

6. Sulphate of copper. 

7. Bismuth. 

8. Sulphate of zinc. 

X. Cardiac Sedatives. 

1. Aconite. 

2. Veratrum viride and album. 

3. Antimony. 

4. Hydrocyanic acid. 

5. Veratrum sabadilla. 

XL Cardiac Stimulants. 

1. Digitalis. 

2. Ammonia. 

3. Ether. 

4. Alcohol. 

5. Caffeine. 

6. Nux vomica. 

7. Ignatia. 

8. Strophanthus. 

9. Adonis vernalis. 



10. Convallaria majalis. 

11. Sparteine. 

12. Amyl nitrite (momentarily). 

13. Opium. 

XII. Counter-irritants. 

Those counter-irritants that blister are- 
called epispastics. They are — 

1. Cantharides. 

2. Thapsia. 

3. Ammonia when under a watch- 

glass. 
Those that redden or produce local 
hyperemia of the skin are — 

1. Mustard. 

2. Capsicum. 

3. Turpentine. 

4. Ammonia. 

5. Chloroform. 

6. Burgundy pitch. 

7. Canada pitch. 

8. Most of the spices. 

Under the name of Escharotics are 
grouped a number of substances capa- 
ble of acting as destructive agents upon, 
the soft tissues of the body. They are — 

1. Chromic acid. 

2. Nitric acid. 

3. Sulphuric acid. 

4. Nitrate of mercury (solution). 

5. Bromine. 

6. Caustic potash. 

7. Caustic soda. 

8. Arsenious acid. 

9. Chloride of zinc. 

10. Vienna paste. ' 

11. Canquoin's paste. 

XIII. Diaphoretics. 

The only ones that we know as direct 
stimulants to the glands are — 

1. Pilocarpus or jaborandi. 

2. Warburg's tincture. 

The others are — 

3. Hot dry and hot moist baths. 

4. Dover's powder. 

5. Alcohol (particularly when hot). 

6. Nitrous ether. 

XIV. DlGESTANTS. 

1. Pancreatin. 

2. Pepsin. 

3. Hydrochloric acid. 

4. Papain. 

5. Diastase. 

XV. Disinfectants. 

1 . Corrosive sublimate. 

2. Chlorine or chlorinated lime. 

3. Carbolic acid. 

4. Chloride of zinc. 



CLASSIFICATION OF DRUGS. 



37 



XVI. Diuretics. 

Those that increase both the solids and 
liquid constituents are probably — 

1. Caffeine. 

2. Squill. 

3. Cant ha rides. 

4. Buchu. 

5. Blatta. 

6. Juniper. 

7. Turpentine. 

8. Uva ursi. 

9. Chimaphila. 

10. Cubebs. 

11. Pareira brava. 

Those which increase the watery con- 
stituents of the urine without in- 
creasing the solids proportionately 
are — 

1. Digitalis. 

2. Vegetable salts of potassium. 

3. Nitrous ether. 

4. Lithium. 

XVII. EtlMINATTVES, 

L The iodides. 

2. The salicylates. 

3. The vegetable salts of potassium. 

4. The lithium salts. 

5. Jaborandi. 

6. Colchicura (^probably). 

XVIII. Emmenagogues. 

The direct emmenagogues are — 



Apiol. 

Binoxide of manganese. 

Permanganate of potassium. 

Cantharides. 

Aloes. 

Myrrh. 

Bue. 

Savine. 

Tansy. 

Pennvroyal. 



11. Guaiac. 
The indirect are — 

1. Iron. 

2. Copper. 

3. Arsenic. 

4. Tonics in general. 

XIX. Emetics. 

The direct are represented by — 

1. Apomorphine. 

2. Ipecac (which is both centric and 

peripheral). 

The peripheral are — 

1. Sulphate of zinc. 

2. Mustard. 

3. Alum. 

4. Sulphate of copper. 

5. Turpeth mineral. 



XX. Expectorants. 
Sedative : 

1. Citrate or acetate of potassium. 

2. Ipecac. 

3. Antimony. 

Those which act as stimulating expec- 
torants are — 

1. Ammonium chloride. 

2. Apomorphine. 

3. Creasote. 

4. Eucalyptus. 

5. Tar. 

6. Terebene. 

7. Oil of sandal-wood. 

8. Lobelia. 

9. Sulphur. 

10. Grindelia robusta. 

11. Garlic. 

12. Squill. 

Besides these we have nux vomica, 
which increases expectoration by stimu- 
lating the nervous system to coughing, 
and thus expels the mucus. Opium and 
the bromides depress the nervous system 
and allay cough, and so decrease expecto- 
ration. 

XXI. Hypnotics. 



Chloral. 

Bromides of potassium, sodium, 



etc. 

3. Opium. 

4. Sulphonal. 

5. Paraldehyde. 

6. Urethan. 

7. Somnal. 

8. Amvlene hvdrate. 

9. Methylal. 
Hypnone. 

11. Hyoscine, in mania. 

12. Cannabis indica (in large dose). 



10 



XXII. Nervous Sedatives. 



9. 

10. 

11. 
12. 
13. 
14. 
15. 
16. 
17. 
18. 
19. 



Chloral. 

Opium (in full doses). 

The bromides and hydrobromic 

acid. 
Chloroform. 
Amyl nitrite. 
Nitrites of potassium, sodium, 

and nitroglycerin. 
Ether. 

Bromide of ethyl. 
Nitrous oxide. 
Bromoform. 
Cannabis indica. 
Belladonna. 
Antipyrine. 
Acetanilide. 
Phenacetine. 
Calabar bean. 
Hydrocyanic acid. 
Lobelia. 
Conium. 



38 



GENERAL THERAPEUTICAL CONSIDERATIONS. 



20. Tobacco. 
'Zl. Sulphonal. 

22. Croton chloral. 

23. Paraldehyde. 

24. Camphor. 

25. Monobromated camphor. 

26. Asafoetida. 

27. Amber. 

28. Hoffmann's anodyne. 

29. Cimicifuga. 

30. Musk. 

31. Valerian. 

32. Humulus. 

33. Castor. 

34. Hypnal. 

35. Somnal. 

36. Amylene hydrate. 

37. Urethan. 



XXIII. Nervous Stimulants. 

1. Nux vomica. 

2. Ignatia. 

3. Coffee. 

4. Coca. 



XXIV. Oxytocics. 

1. Ergot. 

2. Cotton-root. 

3. Ustilago maydis. 

And indirect when in labor ; 
1. Quinine. 



XXV. Tonics. 

1. Cinchona. 

2. Nux vomica. 

3. Calumba. 

4. Arsenic. 

5. Phosphorus. 

6. Mercury (in minute doses). 

7. Copper. 

8. Iron. 

9. Hydrochloric acid. 

10. Nitro-hydrochloric acid. 

11. Nitric acid. 

12. Phosphoric acid. 

13. The vegetable bitters in general, 

XXVI. Vasomotor Depressants. 

1. Veratrum viride. 

2. Antimony. 

3. Aconite. 

4. Veratrum album. 

5. Veratrum sabadilla. 

6. Alcohol (in excessive doses). 

7. Jaborandi. 

XXVII. Vasomotor Stimulants. 

1. Belladonna. 

2. Hyoscyamus. 

3. Digitalis. 

4. Nux vomica. 

5. Ergot. 

6. Stramonium. 

7. Caffeine. 

8. Convallaria. 



PART II. 
DRUGS. 

ACACIA. 

Acacia, U. S., Acacia? G-ummi, B. P., Gum Arabic or Gum Acacia, 
is a gummy exudate from the stems and branches of small trees known 
as Acacia Senegal, and other acacias growing in Northern Africa and 
in Australia. As sold in the stores it consists of irregular semi- 
transparent lumps, which are either smooth or angular, according to 
whether the substance has been preserved in the original beads or 
broken by handling. Its color is slightly yellow or almost white, 
both color and transparency depending largely on the amount of the 
impurities by which it is contaminated. 

It is devoid of physiological action. 

Therapeutics. — Acacia is employed in medicine as a local applica- 
tion to inflamed and irritated mucous membranes, particularly of the 
upper air-passages, and also in the form of a drink in the same condi- 
tions. In instances where genito-urinary irritation exists it is useful 
as a vehicle for more powerful remedies. Made into a mucilage with 
flaxseed, to which liquorice may be added, it is largely employed to 
loosen a hacking cough in children or in adults. The flaxseed should 
not be boiled, but allowed to stand on a moderately warm part of the 
"range," and the gum-arabic solution added with a little lemon-juice 
for flavoring purposes. Acacia is chiefly used in pharmacy for making 
pills, emulsions, and similar preparations, and is official in the form 
of the mucilage of acacia (Mucilago Acacia?, U. S. and B. P.) and 
the syrup of acacia (Syrupus Acacia?, U. S.), the first containing 340 
grms. of acacia and w T ater enough to make 1000 grms., and the sec- 
ond 25 c.c. of the mucilage to 75 c.c. of syrup. 



ACETANILID, or ANTIFEBRIN. 

Acetanilidum, U. S. and B. P., was first employed in medicine by 
Cahn and Hepp, and is a white crystalline material only slightly sol- 
uble in water, but completely soluble in alcohol and ether. Applied 
to the tongue, it causes a burning sensation which is not very severe. 
It has been known to chemists for many years, and is made by the 
action of glacial acetic acid upon aniline, forming in this way acetan- 
ilid or phenyl-acetamide. The word antifebrin is a registered name, 

39 



40 DRUGS. 

and should be avoided by the profession, since its employment obliges 
the druggist to use the acetanilid made by one firm instead of the 
compound made by other chemists, who are able to make the drug as 
an ordinary chemical compound, and do not charge so high a price as 
do those holding control over the registered name. 

Physiological Action. — Acetanilid has been studied experimentally 
and clinically to a very great extent, and fairly definite outlines of 
its action have been mapped out. 

Nervous System. — On the nervous system acetanilid has been 
found to act as a sedative, the sensory portion of the nerves and spinal 
cord particularly being quieted. After a poisonous dose general anaes- 
thesia comes on, with total loss of reflex action and with motor and 
sensory paralysis. The portions of the nervous system involved in 
these changes are, primarily, the sensory side of the spinal cord and 
the sensory nerves, the motor apparatus being least affected. The 
muscles are not influenced by the poison, except indirectly. 

Circulation. — On the circulation acetanilid has but little direct 
influence except when used in poisonous doses. Applied to the frog's 
heart, it at first accelerates its beat and increases its force, but soon 
causes a weakening, ending with arrest in wide diastole. Upon the 
higher animals it causes, in toxic dose, an immediate fall of arterial 
pressure with a diminution in the size of the pulse-waves and all the 
evidences of cardiac and circulatory depression, notwithstanding the 
fact that death ensues from respiratory failure. The cause of this 
fall of blood-pressure is a direct depressing action on the heart asso- 
ciated with failure of the vasomotor system, as asphyxia causes no 
rise in pressure. 

In medicinal dose acetanilid causes no circulatory changes of any 
moment. Sometimes the pulse-rate is increased, sometimes diminished. 
The tendency is, however, toward depression rather than stimulation 
of the circulation. 

Blood. — The action of this drug upon the blood, when used in 
large doses, is more pronounced than its influence upon any part of 
the body, causing this tissue to become brownish-red, decreasing its 
ozonizing and oxygen-carrying power, and, finally, reducing the 
haemoglobin to methaemoglobin to a very considerable extent. The 
question as to the influence of acetanilid upon the corpuscles is still 
somewhat undecided, some observers declaring that these bodies are 
disorganized, while others assert that they remain intact. In mod- 
erately large poisonous doses it may not affect the corpuscles, but if 
its use in large amount be maintained for some days, or a very large 
amount be used at one time, corpuscular destruction certainly occurs, 
free haemoglobin appearing in the urine in its characteristic forms. 
The normal alkalinity of the blood is decreased, and the urine becomes 
dark and brownish in color, so that the blood-crystals of Teichmann 
may be found in it. In ordinary medicinal doses the blood shows no 
change except in cases where idiosyncrasy is present or the doses are 
unusually large. Under these circumstances the blood in the arterial 
system becomes more blue than normal. 

Respiration. — No effect is produced upon this function by acetan- 



ACETANILID, OR ANTIFEBRIN. 41 

ilid when given in moderate doses. When poisonous doses are used 
the breathing at once becomes rapid and then impaired and labored. 
Large doses produce death by paralysis of the respiratory centres. 
The causes of these changes are, primarily, the alterations in the 
blood, which so influence oxygenation of the tissues as to lead the 
respiratory centres to greater effort, while at the same time they are 
beginning to be directly depressed by the drug itself, so that impair- 
ment of their function is soon manifest. Bokai asserts that the drug 
paralyzes the peripheral motor nerves, which, if true, brings forward 
a third factor in the respiratory failure. 

Temperature. — When given in full medicinal doses, acetanilid 
lowers the normal bodily temperature or else fails to produce any 
change. In poisonous doses it produces a decrease in temperature 
depending on the amount employed, and may produce collapse and 
rigors. On a fevered temperature it acts as a powerful and fairly 
constant antipyretic, lowering the fever by decreasing heat-production 
and increasing heat-dissipation, heat-production being the function 
most affected. 1 Whether the decrease in heat-production is due to an 
action on the heat-centres in the nervous system, or upon other causes, 
is not positively known. Some investigators have claimed that the 
fall depends upon the partial reduction of the haemoglobin of the 
blood, whereby less oxygen is carried to the tissues and less combus- 
tion ensues. This seems doubtful, in view of the fact that the most 
careful spectroscopic examination of the blood fails to show any such 
change. That the fall of temperature is not dependent on the sweat 
produced is proved by the fact that the temperature falls even if 
enough atropine be given to stop all perspiration. 

Kidneys, Tissue-waste, and Urine. — Much contradictory evi- 
dence exists in regard to the changes which occur in these organs and 
their excretory products under the influence of acetanilid, but most 
observers agree that the excretion of urea is increased, and it is a 
fact that the more laborious researches which have been undertaken 
have reached a similar result (Lepine, Chittenden, and Taylor). 
Less uncertainty exists as to its influence on uric acid, which is 
increased rather than diminished by the drug. After excessively 
large doses the urine becomes dark from the presence of broken- 
down blood-coloring matter. 

Elimination. — The drug is eliminated by the kidneys in the form 
of para-amido-phenol-sulphate. 

Antiseptic Action. — The drug possesses some slight antiseptic 
powers, but they are only exercised when the amount present is 
quite large. 

Toxic Changes from Prolonged Use. — Although it has been claimed 
that no untoward effects result from the prolonged use of acetanilid 
in large doses, there can be doubt that this is untrue. Under these 
circumstances congestion of the liver, kidneys, and spleen occurs, and 
if the doses be poisonous, clots may be found in the cardiac cavity. 

1 The conclusions of Evans and of the writer have been severely criticised by H. 
C. Wood. My reasons for holding to the opinions stated can be found in my Boylston 
Prize Essay on Antipyretics. Philadelphia, 1891. 



42 DRUGS. 

There may be also a progressive decrease in the number of the red 
blood-corpuscles. 

Poisoning. — In man this drug in toxic quantity causes the lips to 
become blue, the face livid, cyanosed, expressionless, or anxious. 
The forehead and cheeks become covered by beads of sweat, which 
graduall}- extend over the rest of the body. The pulse is soft and 
compressible, but slow, and finally very weak. The respirations are 
slow and shallow. 

The treatment of a case of poisoning by acetanilid should consist 
in supporting measures, the use of stimulants, external heat, bella- 
donna to maintain blood-pressure, strychnine to aid the respiration, 
and oxygen inhalations if they are necessary to overcome cyanosis. 

Therapeutics. — The employment of acetanilid in fevers must depend 
very much upon the exact condition of the patient and the form of his 
disease. The mere existence of a malady, or of a high temperature, 
cannot, correctly speaking, be an indication for any particular rem- 
edy. The phase of the disease must be recognized, and the question 
as to whether the fever which is present is harmful must be duly 
weighed. (See Treatment of Fever, Part IV.) 

In typhoid fever the studies of most clinicians show that though 
the drug possesses very decided antipyretic power, it often causes great 
depression and collapse, and in no way influences the duration or gen- 
eral course of the disease. 

For the same reasons the value of acetanilid in phthisis is doubt- 
ful, since, although it greatly affects the temperature, it is very apt to 
cause collapse, profuse sweating, and depression. Thus the writer 
has seen cases of phthisis where the attempt to control the fever 
resulted in the manner just stated, and Riese points out, what the 
author has also noted — namely, that in this disease cyanosis is very 
apt to come on after the use of the drug. 

In regard to the employment of acetanilid in sthenic fevers, it at 
once becomes evident to the most careless student of medicine that a 
drug absolutely unsuited to a case of asthenic disease may, on the 
other hand, agree with a sthenic-fever patient very well. In conse- 
quence of this, we find that the sweating produced by acetanilid is 
not so marked or troublesome in diseases of a dynamic type, and that, 
in consequence, it more rarely causes collapse. 

In much the same manner that antipyrine was found, some time 
after its introduction, to be possessed of pain-relieving power, so ace- 
tanilid has been discovered to possess similar properties — a discovery 
the credit of w T hich must be given to the French investigator Lepine, 
who has written upon this subject, at various times, very extensively. 
Almost every form of nerve-pain seems to indicate its employment, 
and it has been successfuly used in the crises of ataxia, the agonizing 
dartings of gastralgia, and even in chorea, with good results. In a 
corresponding manner Secretan has obtained brilliant effects in cases 
of sciatica, and Silva has seen the most obstinate headache yield to 
its influence. A large amount of experience has proved it to be of 
value in epilepsy. 

The employment of acetanilid in rheumatism may be separated, 



ACETATE OF POTASSIUM. 43 

if desired, into that devoted to the cure of the disease, with the relief 
of pain, and the reduction of pyrexia. There can be no doubt what- 
ever of the ability of the drug to control the fever of this disease, 
and the question as to whether it favorably influences the progress 
of the malady is to be answered very forcibly in the aflirmative. 
(See Rheumatism, Part IV.) The dose for cases of rheumatism 
should be 4 (0.2) to 6 grains (0.5) three times a day. 

It is claimed by those who have used it the most that acetanilid is 
of great value in the treatment of chancroids when used in dry pow- 
der, and that it is useful in the dressing of wounds antiseptically. 

In many cases of obstinate vomiting, particularly that following 
surgical operations when an anaesthetic has been used, acetanilid is a 
useful drug. The drug is usually best given in the dose of 1 grain 
every half hour until 6 grains are taken ; and the following prescrip- 
tion may be used in compressed tablet, pill, or powder, preferably the 
latter, in order to increase its sedative effect on the stomach and steady 
the heart: 

R. — Acetanilidi gr. vj. 

Caffein. citrat gr. iij. 

Camphor, monobromati gr. vj. — M. 

Ft. in pil. vel chart. No. vi. 
S. — Wash down with a little water or else dissolve powder in a drachm of 
brandy with cracked ice, and give it from a spoon. 

Acetanilid has even been recommended as a haemostatic in epis- 
taxis and haemoptysis. 

Acetanilid very distinctly increases the susceptibility of a patient 
to cold, and it should not be used for the relief of neuralgic or other 
pain before leaving the house in cold weather. 

Untoward Effects are not very common if acetanilid be used with 
care. The writer has collected a number of cases (thirty-eight) in 
which unfavorable signs appeared after its use, but untoward action 
was never seen unless the dose given was excessive for the case which 
received it. The dose most commonly producing such symptoms was 
from 3 (0=15) to 10 grains (0.65). In only three instances of the 
series did death occur — one from heart-clot and two from excessive 
dosage. No deaths were reported from moderate amounts, although 
some of the cases were very alarming. 

Administration. — Acetanilid may be given in doses varying from 
2 (0.1) to 10 grains (0.65), the last-named amount being usually far 
too much. As it is virtually insoluble in water, it should always be 
administered in wine or spirit, in which it will dissolve, or in capsules 
or pills. The antipyretic effect begins to be felt about one hour after 
the drug is taken. When neuralgias are to be treated or similar 
forms of pain are present, monobromated camphor, in the dose of J 
a grain, may be combined with acetanilid with advantage. 

R. — Acetanilidi gr. xx (1.3). 

Camphor, monobromati gr. v (0.3). — M. 

Ft. in pil. No. x. 
S. — One every two hours. 



44 DRUGS. 

This pill is not to be used if there is reason to believe that renal 
congestion or irritation is present. 



ACETATE OP POTASSIUM. 

Potassii Aeetas, U. S. and B. P., is a neutral white salt of saline 
taste, readily deliquescent and soluble in water. It was at one time 
very largely used in the treatment of rheumatism in the "alkaline 
method," as when it enters the blood it is changed into an alkaline 
carbonate. It has, however, been supplanted by the salicylates in 
the treatment of most cases of rheumatism. The dose should be 
from 1 to 2 ounces (32.0-64.0) a day. A combination of 10 grains 
(0.65) of the iodide of potassium and 30 grains (2.0) of the acetate 
is useful in rheumatism in some instances. 

In hepatic torpor acetate of potassium is exceedingly useful, and 
aids in promoting the flow of bile as well as that of the urine. It 
has been used in the treatment of the uric-acid diathesis, and acts 
powerfully in rendering an acid urine alkaline. At one time it was 
supposed to purify the blood by aiding in the oxidation of effete 
material. The dose of potassii aeetas is from 20 grains to 2 ounces 
(1.3-64.0), but the latter dose is only employed when a purgative 
effect is desired. 



ACETIC ACID. 

Acidum Aceticum, U. S. and B. P., as used in medicine, is a 
clear liquid made up of 36 per cent, of acetic acid and 64 per cent, 
of water, and has a sweetish odor. It is obtained from wood by 
destructive distillation. 

Acetum, or Vinegar, is practically a dilute acetic acid. 

Therapeutics. — Acetic acid is seldom used internally, except in 
combination with potassium or sodium. As a powerful escharotic the 
glacial or absolute acetic acid {Acidum Aceticum Glaciate, II. S. and 
B. P.) is used. It can be applied to ivarts and other growths, and 
to old sores where the granulations are profuse and slow to heal. The 
dilute acid (Acidum Aceticum Dilutum, U. S. and B. P.) is used as 
a lotion in night-sweats and to arrest epistaxis and other small haem- 
orrhages. As a lotion to be widely employed it should be diluted 
one-half Vinegar, or dilute acetic acid, has been used internally 
for the decrease of obesity, but is a harmful and useless remedy, dis- 
ordering digestion and reducing the patient's strength. 

In the following mixture acetic acid has been used with success 
for the removal of vegetations about the external genitals : 

R. — Acid, salicylic gr. xxx (2.0). 

Acid, acetic f 5j (32.0).— M. 

S. — Apply with a camel's-hair brush. 

Very little pain is caused by this application. 



ACONITE. 45 

Poisoning. — When over-doses of acetic acid are taken the treat- 
ment consists in the use of large doses of milk, alkaline liquids, such 
as lime-water, soap-water, etc., and the general measures adopted for 
the treatment of gastro-enteritis. (See Gastro-enteritis, Part IV.) 

Contraindications. — Nursing mothers should not take freely of 
vinegar, as it may produce a troublesome diarrhoea in the nursling. 



ACONITE, or MONKSHOOD. 

The aconite of the U. S. P. is derived entirely from the tuberous 
root of Aconitum Napellus. At one time the leaves were official, but 
are so no longer, and for this reason the term " radix " is not to be 
employed, as it is a useless distinction. 

Aconite is indigenous in Germany, France, and Switzerland, and 
is cultivated as a garden-plant all over Europe and America. The 
root is so strikingly like that of horseradish as to be readily confused 
with that article of food, but does not emit the pungent fumes of the 
latter when it is scraped or broken. It is to be remembered, how- 
ever, that it produces a distinct feeling of heat in the mouth when 
chewed. The active principle upon which the therapeutical value of 
aconite would appear to depend is aconitine, but there is reasonable 
doubt whether this can be relied upon as completely as the fluid 
preparations of the crude drug ; the aconitine of commerce, more- 
over, varies very much in strength, because some of it is amorphous 
and impure, while other samples are very pure and crystalline. Fur- 
ther than this, even the crystalline form is exceedingly variable. In 
addition to aconitine, Dunstan asserts that there are two amorphous 
alkaloids — namely, aconine and napelline — and this investigator 
believes that there is a fourth alkaloid closely allied to napelline. 

Physiological Action. — Nervous System. — Aconite in full medi- 
cinal dose depresses the functional activity of the perceptive centres 
in the brain, the sensory side of the spinal cord, and, finally, the 
peripheral ends of the sensory nerves. Applied to a mucous mem- 
brane, it acts as a local anaesthetic, but is too irritating for use in the 
eye. On the motor portion of the body it exerts little influence unless 
given in large poisonous doses, when it paralyzes the motor tract of 
the spinal cord and the peripheral motor nerves. 

Circulatory System. — On the heart aconite acts, when given in 
moderate doses, as a quieter of its movements and force, and lowers 
blood-pressure and pulse-rate by a direct action on the heart-muscle. 
There is no good experimental evidence of its possessing any direct 
influence on the vasomotor system, but clinically it seems to possess 
this power. In poisonous dose it causes first a very marked fall in 
pulse-rate, preceded sometimes by a quickening due to a condition of 
weakness and abortive cardiac action : this condition gradually passes 
into diastolic arrest of the heart-beat, the viscus becoming paralyzed 
and refusing to respond to stimuli. 

Respiration. — In moderate doses aconite quiets the respiratory 
movements slightly, particularly if the breathing is hurried before 



46 DRUGS. 

its use. In poisonous doses it paralyzes the respiratory centres, and 
so causes death. 

Temperature. — Aconite acts as a distinct reducer of fever, prob- 
ably because of increased heat-radiation arising from relaxation of 
the capillaries and impaired circulation. 

Kidneys. — In fever aconite usually increases the urinary flow. 

Poisoning. — When aconite is taken internally in excessive amount 
it causes tingling of the mucous membranes wherever it touches them, 
which sensation finally amounts to severe burning. This soon passes 
away, and is followed by a sense of tingling about the lips and finger- 
tips or all over the skin. At the same time the patient feels relaxed ; 
the pulse at first becomes slow and weaker, but later on rapid and 
running, so that it seems a mere trickle under the finger ; sweating 
more or less severe is present, and fainting may ensue. Vomiting 
may occur, but is rare. The respirations now become slow and shal- 
low, seeming to expand the lung in the smallest possible degree. 
The face is pallid and anxious. There may be exophthalmus, or the 
eyes may be sunken and dull. There is excessive pallor. Epilepti- 
form convulsions may be present, due to disorder of the circulation 
at the base of the brain. Previous to this there may be marked 
anaesthesia of the skin. The pupils may be normal, or dilated to a 
wide degree. The sclerotic coat of the eye is pale and pearly-look- 
ing. The temperature is very low. Death may be gradual or sud- 
den, the slightest movement of the body which can throw any strain 
on the heart stopping that organ in diastole. 

Treatment of Poisoning. — The patient is to be placed in a 
prone position or on a board, with the feet higher than the head, in 
order to confine the circulation as far as possible to the vital centres 
at the base of the brain. Hot bottles or bricks are to be placed 
about the body for the purpose of maintaining the bodily heat. 
Emetics are not to be given if the symptoms are severe, as vomiting 
may cause cardiac arrest owing to the muscular effort involved, or the 
stomach may be so depressed that the emetics will not act. If vom- 
iting comes on, let it be into a towel without the patient being allowed 
to raise the head. The stomach is to be washed out by means of a 
stomach-pump or a siphon made of rubber tubing. Ether may be 
g;iven hypodermically, and followed by alcohol, and this again by 
digitalis. The ether acts at once, and lasts while the alcohol is being 
absorbed, and the alcohol supports the heart until the digitalis, which 
is the physiological antagonist of aconite, but slow and prolonged in 
its effects, asserts itself. If the breathing fails, artificial respiration 
is to be employed, or if the heart seems about to cease its action, a 
whiff of the nitrite of amyl may start it going again, but only a few 
drops of the nitrite should be used, as large amounts depress this 
organ. Full hypodermic doses of strychnine, such as -^V to ^ (0.003- 
0.006) of a grain, may be given to stimulate the respiration and heart. 
Aconite may cause in susceptible persons a vesicular, or even a pus- 
tular, eruption, or intense itching of the skin may be developed. 

Therapeutics. — The employment of aconite in disease is one of the 
most universally recognized procedures in medicine. It fulfils indi- 



ACONITE. 47 

cations which nothing else can, and lends itself to the control of a 
large number of morbid processes, its effect being uniformly explain- 
able by its known physiological action. It is used chiefly for its 
influence as a cardiac and circulatory quieter, for its effects on the 
peripheral sensory nervous system, as in the vomiting of pregnancy, 
and in those states in which, through inflammation elsewhere, the 
nervous system needs a sedative which will simultaneously reduce 
arterial tension. In the early stages of all acute inflammations aco- 
nite is of service. It may be applied locally over superficial nerves 



in neuralgia in the form of an ointment (2 grains [0.1] to 1 drachm 

[4.0], or as the oleate of aconitine, 2 grains [0.1] of the c 

100 [6.0] of sweet oil). In the earliest stages of gonorrhoea aconite 



in small doses frequently repeated is a most valuable remedy, and 
later in the disease tends to prevent chordee by its influence on the 
nervous centres. It is useful in croup, quinsy, sore throat, severe 
colds, bronchitis and asthma due to exposure, in their early stages. 
When suppression of menstruation follows an exposure to cold, this 
drug will often restore the normal flow. In pericarditis it is valu- 
able to allay the inflammation and quiet the excited heart, and it is 
also of great value in the earliest stages of pneumonia. It ought 
not to be used in adynamic, asthenic affections. Aconite is useless 
and harmful in prolonged acute diseases, such as scarlet fever, if 
constantly employed. 

In persons who suffer from asthma which is preceded by coryza 
aconite does good in the earliest stages. 

In nervous palpitation of the heart and in the palpitation of exces- 
sive cardiac hypertrophy aconite is very valuable. In the epistaxis 
of full-blooded people it often affords great relief. Aconite is by far 
the best circulatory and nervous depressant for children suffering 
from sthenic fevers, particularly of the irritative type. 

Administration. — As a general rule, small divided doses of the 
drug in the form of the tincture, \ to \ a drop (0.015-0.03) given 
every fifteen minutes, will act better than a full dose given at once, 
unless the condition of the patient requires very active treatment. 

Preparations. — Tincture of aconite (Tinctura Aconiti, XI. S. and 
B. P.) is used in the dose of 1 to 5 drops (0.06-0.3) in water, re- 
peated every hour if needed so often. A very useful way of employ- 
ing it is in the form of tablet triturates. The extract of aconite 
(Jb'xtraetum Aconiti, U. S.) is given in the dose of -J- to f of a grain 
(0.015-0.045), while of the abstract (which is no longer official) 1 
grain (0.05) is used. The fluid extract (Bxtr actum Aconiti Fluidum, 
U. S.) is given in the dose of 1 to 2 minims (0.05-0.1). Fleming's 
tincture ought never to be used. The active principle aconitine is 
not official in the U. S. P. Its dose is ^ito to tw °f a g ra i n (0.0003- 
0.0006), but it ought never to be used internally. The B. P. prepa- 
rations that are not official in the U. S. P. are : aconite-leaves 
(Aconiti Folia) aconitine (Aconitina), aconite ointment ( Unguentum 
Aconitince), and aconite liniment (Linimentum Aconiti). The dose 
of the extract of aconite (Extractum Aconiti, B. P.) is -J- to 1 grain 
(0.03-0.06). 



48 DRUGS. 



ADONIS VBRNALIS. 

From Adonis ve?malis, a plant indigenous in Europe and Asia, is 
derived a glucoside, Adonidin. When given to one of the mammalia 
— the dog, for instance — it causes an increase in heart-force and a 
rise of arterial pressure. In the frog poisonous amounts arrest the 
heart in diastole. 

The indications for the use of adonis are all conditions of cardiac 
failure, particularly the presence of cardiac dropsy. It is much infe- 
rior to digitalis and caffeine, but may be employed when these fail, as 
it sometimes succeeds under such circumstances. The dose of adoni- 
din is -J to \ of a grain (0.008-0.016) three times a day; or, 4 to 8 
parts of the plant — all portions of which are employed — may be 
added to 180 parts of water, and of this infusion a tablespoonful 
(16.0) may be given every four hours. 



AGARICIN. 

Agaric, or Touchwood, or Punk, has been used in the Southern 
United States very largely in the dose of 5 grains (0.3) every few 
hours in the treatment of the night-sweats of phthisis; and agaricin, 
the alcoholic extract of the drug, has been used with very extraordi- 
nary results, under these circumstances, by certain German and 
English physicians, in the dose of from 1 to 2 grains (0.05-0.1) 
every five hours. Its physiological action is unknown, but it is sup- 
posed to act upon the nerve-filaments in the sweat-glands. The 
writer has employed it frequently in varying dose, and has never 
seen any decrease whatever produced by it in the sweats of phthisis, 
although he has watched it most closely, expecting to see great relief 
follow its use. 

ALCOHOL. 

Ethyl Alcohol (Alcohol Ethylicum, B. P.) is the only alcohol used 
in medicine. Some of the other alcohols are exceedingly poisonous. 
Amylic alcohol is fusel oil. 

Alcohol is a liquid derived from the fermentation of starches or 
sugars in the presence of heat. It is official in four forms — namely, 
as Alcohol, U. S., containing 91 per cent, by weight of the spirit and 
9 per cent, of water ; Alcohol Absolutum, U. S., containing not more 
than 1 per cent, by weight of water ; Alcohol Deo dor at um, containing 
92.5 per cent, by weight of alcohol; and Alcohol Dilutum, U. S., or 
dilute alcohol, 41 per cent, by weight spirit and the remainder water. 
The drug is generally given in the form of whiskey or brandy, and 
when the word alcohol is used in the saying, " Give the patient alco- 
hol," one of these two liquids is always meant unless it is otherwise 
stated. 

Physiological Action. — Nervous System. — Alcohol acts first as a 
powerful excitant, and afterward, when given in very full dose, as a 



ALCOHOL. 49 

most active depressant and paralyzant of the nervous system. Locally 
applied in small amounts to the peripheral nerves, it excites them at 
first and paralyzes them afterward. By the primary stimulation of 
the brain it increases the rapidity, but not the depth, of thought, and 
it increases the reflex activity of the spinal cord, the muscles, and 
the nerves. In large doses it produces lack of co-ordination by 
depression of the brain and lower nervous system, the loss of co-ordi- 
nation being due largely to sensory paralysis, so that the power of 
touch is interfered with. This makes a drunken man fail to recog- 
nize the angles and surfaces of obstructions, and the impaired mental 
power and disordered judgment, combined with the badly-acting 
motor and sensory pathways, cause him to stumble and fall. 

Circulatory System. — When alcohol is ingested, either by man 
or the lower animals, it stimulates the heart-muscle and increases the 
rapidity as well as the force of its beat. According to Dogiel, the 
increase in rate is partly due to stimulation of the accelerator nerves, 
but Castillo denies any such influence. Wood teaches that the effect 
of alcohol is not through any action upon these nerves, and is prob- 
ably correct in his belief. Along with the stimulation of the heart a 
rise of arterial pressure ensues, largely due to increased heart action 
and partly to vasomotor stimulation. In very large toxic doses alco- 
hol depresses and finally paralyzes the heart and vasomotor system as 
well as the nervous system. 

Respiration. — Respiration is stimulated by small doses of alco- 
hol and decreased by large ones. 

Temperature. — Alcohol at no time increases to any extent the 
actual number of heat-units in the body. It produces a sensation of 
warmth, and warms the extremities by causing the heart to pump hot 
blood from the centre of the body to the cold parts. If it be used in 
excess, the temperature rapidly falls, owing primarily to the increase 
of heat-radiation produced by the excessive distribution of heat just 
named, and secondarily by the depression of vital power, which is 
caused by a too rapid destruction of the tissues of the body in the 
effort induced by the drug. Calorimetrical studies show that, while 
more heat may be created under its influence, so much heat is dissi- 
pated that the temperature nevertheless falls. 

Bodily Metabolism. — The quantity of carbonic acid given off 
by the body under the use of alcohol is in most instances increased, 
but it may be decreased. The effect on the absorption of oxygen is 
not known. Some observers have noted an increase, some a decrease, 
of such absorption, and some no change at all when alcohol is taken. 
Upon the giving off of nitrogenous substances it acts as a decided 
depressant, which seems to prove that it inhibits rapid tissue-changes 
and is a conservator of vital power. It adds force, but not tissue, to 
the body. 

Elimination. — Alcohol is largely "burnt up" in the body, but 
when taken in excess of the latter's oxidizing power it is eliminated 
by the breath and by the skin, kidneys, and intestines. 

Digestion. — Alcohol added in any amount to food in a test-tube 
containing digestive ferments retards or inhibits digestion, but in the 

4 



50 DRUGS. 

stomach, on the other hand, it assists the process ; for by reason of 
its irritant and stimulating properties it induces the secretion of an 
excess of the digestive juice. 

Therapeutics. — The employment of alcohol in disease can here be 
only briefly alluded to, special mention of its indications being named 
where the diseases in which it is used are discussed. Its chief uses 
are as a rapidly-acting stimulant in all forms of cardiac failure due 
to shock or to poisons, and as a systemic support and stimulant in 
low fevers and prolonged wasting diseases, in old age, and in conva- 
lescence from acute disease. 

Some of the conditions, to state them specifically, in which alco- 
hol is indicated, are fainting, snake-bite, surgical shock, acute, sub- 
acute, and chronic pneumonia in its later stages, and excessive wasting 
due to prolonged suppuration. 

Alcohol should never be given in sthenic fevers unless some com- 
plication, such as syncope or pneumonia, comes on. The reason it is 
contraindicated is that in sthenic fevers the circulation is already suf- 
ficiently excited, and is generally in excess of the needs of the system. 
In the pneumonia of children, whether it be croupous or catarrhal, 
brandy or whiskey is very useful in the dose of 5 to 60 drops (0.3- 
4.0) every two hours in a little water or milk. (See Administration.) 
In exhausting fevers, such as typhoid or typhus, alcohol finds its true 
usefulness. While it is Avell to give alcohol in many cases from the 
beginning to the end of the attack, for the double purpose of aiding 
digestion and of supporting the system, its administration should not 
be a mere matter of routine, but should be based upon clear ideas of 
the indications it is calculated to fulfil. If the pulse is weak and the 
patient seems to be sinking, or the appetite is failing and adynamia 
is a pressing symptom, alcohol is indicated ; but if the pulse is good, 
and the passage of the patient through his illness is not a stormy one, 
alcohol should be excluded from the sick-room. Sometimes ordinary 
whiskey or brandy will in severe typhoid disorder the stomach. The 
physician should then employ an old brandy or wine which has 
acquired an aroma which is called a bouquet. 

Acute Poisoning. — In advanced poisoning by alcohol, with coma 
and total relaxation, external heat and hypodermic injections of digi- 
talis and strychnine are indicated if the heart or respiration seems 
failing. Belladonna should be administered to stimulate the vaso- 
motor system if the skin is relaxed and clammy, and counter-irrita- 
tion to the back of the neck is to be employed if any brain symptoms 
seem pressing. The after-treatment consists in the use of substances 
stimulating to the stomach, such as ammonia, spirit of Mindererus, 
and spices, unless there is gastric inflammation, when emollient sub- 
stances should be used to quiet the irritation. If persistent vomiting 
comes on, it must be quieted by the patient swallowing pieces of ice, by 
aconite, cocaine, or minute doses of ipecac. Counter-irritation should 
be applied over the belly. If the emunctories are not acting freely, 
thorough purgation by jalap or elaterium (40 grains (2.8) of jalap 
powder or -J of a grain (0.01) of elaterium) should be employed; or cal- 
omel followed by a saline may be given if milder effects are sought. 



ALCOHOL. 51 

In view of the frequency with which alcoholic and opium poison- 
ing are confused, the following table is appended, which will be found 
of value in making a differential diagnosis as to the condition of the 
patient : 

Alcoholism and Opium Poisoning. 
A Icoholism. Opium Poisoning. 

1. Pupils normal or dilated. 1. Pupils contracted. 

2. Eespiration nearly normal. Pulse 2. Kespiration and pulse slow and full, 
rapid, and finally feeble. 

3. Face may be pallid. 3. Face suffused and cyanosed. 

4. Skin cool, perhaps moist. 4. Skin warmer than in alcoholic poi- 

soning. 

5. Pulse rapid, at first strong, then 5. Pulse slow, strong, and full till late 
"weak. in poisoning. 

There is scarcely any difference as to consciousness in the two conditions. 
The urine is always to be saved for medico-legal examination. 

Acute Alcoholism and Apoplexy. 
A Icoholism. • Apoplexy. 

1. Pulse rapid, compressible, and weak. 1. Pulse apt to be strong and slow. 

2. Skin moist, or relaxed and cool. 2. Skin hot or dry. 

3. Bodily temperature lowered. 3. Bodily temperature raised. 

4. Pupils equally contracted or dilated; 4. Pupils unequal, 
generally dilated. 

5. No hemiplegia. 5. Hemiplegia : one side tossed, the 

other remaining motionless. 

6. Breathing not so stertorous nor so 6. Kespiration stertorous, the lips being 
one-sided in lips. inflated on one side on expiration. 

7. No facial palsy. 7. Facial palsy. 

8. Unconsciousness may not be com- 8. Unconsciousness complete, 
plete. 

The smell of alcohol in the breath is no guide, as acute alcoholism may have caused 
the rupture of a cerebral blood-vessel. 

Chronic Poisoning. — The treatment of this condition may be car- 
ried out in two ways : First, by the isolation of the patient and the 
complete withdrawal of the drug at once ; secondly, by, what is better, 
a gradual tapering-off in the daily amount of the spirit. In either 
inscance isolation must be absolute, and all smuggling of alcohol to or 
by the patient prevented. The attendants must be absolutely trust- 
worthy. Careful scrutiny of bed-clothes and closets will often be 
rewarded by finding hidden bottles. The depression of the patient 
when recovering from alcoholism must be met by the use of nutritious 
broths highly seasoned in order to stimulate the stomach, by easily 
digested or predigested foods, and by small doses of morphine or coca 
if the patient be very weak and need such a stimulus. Koumyss is 
an exceedingly valuable preparation under these circumstances. 

In the treatment of the atonic stomach of drunkards nothing does 
.so well as the following pill : 

R. — Oleoresin. capsici rr\,x(0.65). 

Olei caryophylli . tr^x (0.65). 

Hydrarg.chlor. mit gr. xx (1.3). 

Aloe Socotrinre gr. xl (2.65). — M. 

Ft. in pil. No. xx. 
S. — One three times a day after or before meals. 

If this pill fails to move the bowels, a saline purgative should be used. 



52 DRUGS. 

The following are the principal points in the differential diagnosis of 

Chronic Alcoholism and the General Paralysis of the Insane. 

Alcoholism. Paretic Dementia, 

1. Attacks shorter, and more widely 1. Attacks more prolonged, 
separated by intervals of sanity. 

2. Delirium may be of any character. 2. Delirium of grandeur more marked 

and defined. 

3. Visions more characteristic, and are 3. Visions often not evil, but pleasant, 
evil. 

4. Tremors confined to head and arms. 4. Tremors more diffused. 

5. Tremors removed by dose of alco- 5. Tremors made worse by alcohol, 
hoi. 

6. Mental symptoms temporarily re- 6. Mental state made worse by alcohol, 
moved, or at any rate improved, by al- 
cohol. 

7. Tremors occur chiefly in the morn- 7. Tremors not confined to the morn- 
ing, ing. 

There is danger of pneumonia from failure of the right side of the 
heart in subacute and chronic alcoholism, and the physician should 
always be on the lookout for this complication. 

Administration. — Brandy and whiskey are generally used as rapidly- 
acting stimulants. They should be exhibited in the form best adapted 
to the work they are intended to perform. If the action must be 
instantaneous, as in a case of fainting, they should be employed hot 
and concentrated, so that the stomach has not to warm the liquid 
before absorption. They are to be used hypodermically if still more 
rapid action is required. If administered to aid digestion and support 
the system, then they should always be given ivith the food — never 
alone, and never concentrated. They may be given as milk-punch or 
as eggnog, the latter being the " heavier " of the two so far as diges- 
tion is concerned. In fevers of a typhoid type the dose of whiskey or 
brandy should be for an adult from 1 to 4 tablespoonfuls every three 
or four hours. More than a pint in twenty-four hours is rarely re- 
quired, but this amount often does great good and is not excessive. 
When brandy or whiskey is given to children, the following rules as to 
dosage may be used as indicating the approximate proper dose : 5 to 
10 drops every four hours for a child of 1 month old ; 10 to 20 drops 
for a child of 2 months old ; 20 to 30 drops for a child of 3 months 
old ; 30 to 40 drops for a child over 3 months old ; 60 drops for a child 
over 4 months old. In some cases, however, it is well to use half 
these doses every two hours. In all cases the liquor should be diluted 
with hot or cool water. Wine-whey is very light and useful. Mulled 
wine and champagne are particularly useful in the treatment of irri- 
table stomach. (See Foods for the Sick.) Champagne should always 
be as devoid of sugar as possible — that is, what is known as " extra 
dry." Gin is rarely employed as a stimulant, except when the kidneys 
are torpid. Stout and porter are of value in wasting diseases, in con- 
valescence from acute diseases, and for nursing women. 

Contraindications. — All states of cerebral excitement, unless due to 
exhaustion, acute inflammations, the alcoholic habit, apoplexy, menin- 
gitis, acute nephritis, aneurism, and advanced atheroma, contraindicate 
the use of alcohol. 



ALLIUM. 53 

The official preparations of alcohol are as follows : 

Whiskey (Spiritus Prumenti, U. S.) should be at least three years 
old, and be made, in America, from rye for medicinal purposes. 

Brandy (Spiritus Vini Gallici, U. S. and B. P.) is obtained by the 
distillation of fermented grapes or fruits, and should be from three to 
five years old before use. 

Cologne-water (Spiritus Odoratus) is used solely as a lotion and 
perfume. 

Red Wine ( Vinum Rubrum, U. S.) is made from grapes not deprived 
of their skins. White Wine ( Vinum Album, U. S.) is the fermented 
juice of grapes the skins of which have have been removed. 

Dilute Alcohol [Alcohol Dilutum, U. S.), deodorized alcohol 
{Alcohol Beodoratum, U. S.), pure alcohol {Alcohol, U. S.), and 
absolute alcohol (Alcohol Absolutum) are also official. 

The unofficial preparations are : 

Rum, which is made from the fermentation of molasses, and con- 
tains about 40 to 45 per cent, of alcohol. 

Gin is made from rye or barley, with the addition of juniper-berries 
and hops. (Good gin and the Spiritus Juniperi Compositus of the 
U. S. Pharmacopoeia are virtually identical therapeutically.) When 
diuresis is required and atony of the kidneys is present, without 
inflammation, gin is a useful medicament, provided that a stimulant 
is indicated. Gin is one of the alcoholic drinks most apt to produce 
cirrhosis of the liver. 

Port Wine ( Vinum Portense, B. P.) is a fermented wine, to which 
pure spirit is added to increase its strength. It is one of the strongest 
table wines, and is useful as a stimulant in convalescence. 

Sherry ( Vinum Xericum, B. P.) has about 30 per cent, of alcohol 
in it. It is not official in the U. S. P. 

Beer is made by a slow fermentation, while ale is made by a more 
rapid fermentation at a higher heat. 

Porter resembles the other malt liquors closely, except that it con- 
tains more solids, due to a scorching of the grain by a high heat. 

The B. P. preparations that are not official in the U. S. P. are 
rectified spirit (Spiritus Reetificatus), proof spirit (Spiritus Tenuior), 
sherry (Vinum Xericum), amylic alcohol (Alcohol Amylicum), and 
Mistura Spiritus Vini G-allici, which is a useful, pleasant and nutri- 
tious stimulant made by beating up the yolks of two eggs with half 
an ounce of sugar, and then adding four ounces each of brandy and 
cinnamon-water. This is sometimes called "egg-flip." 

ALLIUM. 

Garlic, or Allium Sativum, U. $., is a stimulant to digestion, owing 
to the volatile oil it contains, which by its somewhat irritating proper- 
ties excites the gastric mucous membrane to increased secretion. In 
persistent colds, where the bronchial tubes are particularly affected, a 
garlic poultice, made by pounding the bulbs in a mortar, is a very 
efficient, though disagreeable, remedy. In the treatment of children 
with colds garlic may be used boiled in milk, and the liquid given as 



54 DRUGS. 

a drink, warm or cold, or the oil of garlic may be given in emulsion 
in the dose of 1 or 2 drops (0.05-0.1). It ought not to be given dur- 
ing the febrile stage, as it is stimulating. If the skin in any case is 
too delicate to permit of the use of pounded garlic alone, it may be 
mixed with equal parts of bran, and a regular poultice or plaster 
made thereof. Employed in this form, allium is useful if applied 
over the spine or feet in the treatment of the cerebral and spinal con- 
vulsions of infants ; placed over the belly in cases of g astro-intestinal 
catarrh, it acts almost as well as a spice poultice. Allium-juice has 
also been used, in the dose of 2 to 5 drops (0.1-0.3) to relieve ner- 
vous vomiting. The dose of the syrup (.Syrupus Alii, U. S.) for a 
child is 1 drachm (4.0), but 4 drachms (16.0) may be given to an adult. 



ALLSPICE. 

Allspice, or Pimenta ( U. S. and B. P.), is the nearly ripe fruit of 
Pimenta officinalis, a tree of the West Indies. It contains an official 
volatile oil {Oleum Pimentos, U. S. and B. P.), used for flavoring pur- 
poses, as a constituent of spice plasters, in diarrhoea mixtures, or as a 
carminative. It will also prevent the griping of purgative medicines. 
The dose of the oil is 1 to 5 drops (0.06-0.3). Aqua Pimento? (B. 
P.) is given in the dose of 1 to 2 ounces (32.0-64.0). 



ALMONDS. 

Almonds are official in the form of the bitter almonds (Amygdalus 
Amara, U. S. and B. P.) and the sweet almonds (Amygdalus Dulcis y 
U. S. and B. P.). Bitter almonds develop hydrocyanic acid in the 
presence of water, by the reaction between the amygdalin and water 
in the presence of the emulsin contained in them ; this is not the 
case with sweet almonds. 

Sweet almonds, when rubbed up in a mortar with water, form a 
pleasant-tasting emulsion of an agreeable odor that is very useful as a 
vehicle for remedies having a disagreeable taste. Almond bread has 
been proposed as a food for diabetics, owing to its containing virtually 
no starch ; but it is requisite that the oils and saccharine constituents 
of the almond shall first be removed. (See Foods for the Sick.) 

When half an ounce of swee^ almonds are rubbed up with thirty- 
grains of gum arabic and two drachms of sugar, to which is added 
gradually a half-pint of distilled water, the mixture being then 
strained, an emollient and soothing drink is formed, which is very 
useful in irritations of the stomach and intestines and of the air-pas- 
sages and pharynx. The expressed or essential oil of almonds is a 
useful demulcent, and has been recommended in the cough of phthisis , 
given in the dose of a few drops in emulsion. 

Bitter almonds give oif an oil {Oleum Amygdalce Amarce, U. S.\ 
which is exceedingly poisonous, OAving to the prussic acid which it 
contains, and it is said that one drop will kill a cat, while seventeen 
drops have killed a man. 



ALOES. 55 

Bitter almonds are used to allay irritable coughs and similar states, 
but are not frequently employed, because other drugs are less danger- 
ous, more stable, and more active as remedial agents. The emulsion 
of bitter almonds is made as is that of sweet almonds, and may be used 
in teaspoonfal doses for the same purposes and as a vehicle in cough 
mixtures. Both emulsions are useful as vehicles in the treatment 
of gonorrhoea, as they diminish the burning on urination. Almond 
emulsions, when locally applied, are supposed to be of value for the 
removal of freckles and sunburn. 

The preparations of sweet almonds are : an emulsion (Bmulsum 
Amygdala?, U. S. and B. P.), dose 1 to 2 ounces (32.0-64.0); a 
syrup {Syrupus Amygdala?, U. $.), dose 2 drachms to 2 ounces (8.0- 
64.0); a compound powder {Pidvis Amygdala? Compositus, B. P.), 
given in the dose of 1 to 2 drachms (4.0-8.0); and the oil {Oleum 
Amygdalce Expressum, U. S. and B. P.), the dose of which is 1 to 4 
drachms (4.0-16.0) Aqua Amygdalce Amarce {U. S.) is prepared 
from the oil of bitter almonds. The dose is 30 to 60 drops (2.0-4.0). 



ALOES. 

Aloes, or Aloe of the U. S. P., is derived from Aloe Perryi, or 
Aloe vera. In the U. S. P. of 1890 the first is called Socotrine aloes 
{Aloe Socotrina, U. S.), the second Barbadoes aloes {Aloe Barbaden- 
sis, U. S., B. P.). It is the inspissated or dried juice of the leaves 
of the plant. It is also probably derived from several other species. 
Aloes contains an active principle known as aloin {Aloinum, XT. S.\ 
which is a crystalline substance. As aloin is generally sold it is, 
however, an amorphous powder of extremely bitter taste. 

Physiological Action. — Locally applied to the tongue, aloes is a 
bitter of rather a persistent taste. According to the studies of Ruther- 
ford, the drug increases very considerably the flow of bile in the dog, 
but in man it cannot in any sense be regarded as a medicament for 
the production of an increased biliary flow. Rutherford's doses given 
to the dog amounted to as much as sixty grains, equal to three or 
four drachms in man. In the lower animals and in man aloes acts 
very slowly, requiring many hours for its influence to be distinctly 
felt, unless the dose be toxic in amount. As much as four drachms 
of aloes have been injected into the veins of a horse without inducing 
purgation, probably because four drachms were not enough to affect 
the bowels. Aloes has been used endermically, and when so employed 
is said to act thoroughly. It is eliminated by the milk of nursing 
women, and will cause purgation in an infant put to the breast of a 
patient taking it. If the doses be quite large (10 to 20 grains), the 
passages will be watery ; but if the dose be more moderate (2 to 3 
grains), the stools will be thick and pultaceous. 

Therapeutics. — Aloes should be used only when a somewhat slow 
stimulant to peristaltic movement is desired, and never where the 
object of the physician is to relieve congestions by depletion through 
the intestine. It is a favorite remedy in cases of subacute or chronic 



56 DRUGS. 

constipation, but is distinctly harmful if continued constantly for any 
length of time, as it seems to produce atony of the bowel. Owing to 
its bitter properties it acts as a tonic to the stomach and is often 
given with iron to promote the absorption of this metal by stimulat- 
ing the liver and by preventing any constipation which might be pro- 
duced by the chalybeate. 

When taken in a large enough dose to produce a copious passage, 
aloes nearly always produces a feeling of weight and fulness in the 
region of the rectum after the evacuation, and the writer has seen 
severe rectal catarrh produced in this way. If given alone it is very 
apt to produce griping, and it ought always to be combined with 
other drugs whose tendency is to prevent intestinal spasm. 

In cases of hcemorrhoids occurring in persons suffering from gen- 
eral muscular relaxation and atony, aloes is said to do great good, 
but its use under these circumstances is by no means universal or 
generally accepted as correct. For weak, anaemic persons leading 
sedentary lives it may be combined with tonics to relieve the consti- 
pation so often a pressing symptom in these cases. In amenorrhoea 
dependent upon atony of the sexual system, or anaemia, or constipa- 
tion, it is thought to have a specific emmenagogue influence. Locally 
applied in the form of the glycerole of aloes, it has been employed in 
the healing of old or new fissures of mucous membranes, and even in bed- 
sores. The glycerole of aloes is to be made by evaporating four to eight 
parts of tincture of aloes and gradually adding thirty parts of glycerin. 

Contraindications. — Constipation occurring in plethoric persons 
should not be treated by aloes, and it should not be used if any irri- 
tation or catarrh of the intestine is present. Pregnant women should 
use aloes most carefully, lest abortion be produced, and if hepatic 
congestion or inflammation is present it ought not to be used. Fever 
is said to contraindicate the use of aloes, as does rectal catarrh. 

Administration. — Aloes is generally given in a pill, combined with 
spices and belladonna. (See Constipation, Part IV.) The dose should 
be about 1 to 5 grains (0.06-0.3) as a laxative, and 10 grains (0.6) as 
a purge. The Aloe Purificata, U. S. P., should always be used. The 
official preparations most commonly employed are the pill of aloes 
(Pilulo? Aloes, U. S. and B. P.), 2 grains (0.06) each of aloes and 
soap ; the pill of aloes and myrrh (Pilula? Aloes et Myrrho?, U. S. 
and B. P.), 2 grains (0.12) of each constituent; the pill of aloes and 
mastich (Pilulo? Aloes et Mastiehes, U. S.), 2 grains (0.12) of aloes, 
or the "Lady Webster dinner pill;" the pill of aloes and iron 
(Pilulce Aloes et Ferri, U. S. and B. P.), 1 grain (0.06) of aloes and 
1 grain (0.06) of dried sulphate of iron; and the pill of aloes and 
asafoetida (Pilulae Aloes et Asafoetida?, U. S. and B. P.), containing 
4 grains (0.26) of aloes, asafoetida, and soap. The dose of all these 
is one to two pills. Aloes is also official as Pxtractum Aloes Aquo- 
sum, dose 1 to 2 grains (0.06-0.12). The liquid preparations are the 
tincture (Tinctura Aloes, U. S. and B. P.), dose 1 to 3 fluidrachms 
(4.0-12.0); the tincture of aloes and myrrh (Tinctura Aloes et 
Myrrhce, U. S.), 1 dose 1 to 2 fluidrachms (4.0-8.0) ; and the wine of 
1 Sometimes called Elixir Proprietatis. 



ALUM. 57 

aloes ( Vinum Aloes, B. P.), containing cardamoms and ginger, the 
dose of which is -J- to 1 drachm (2.0-4.0) or even 2 drachms (8.0). 
The B. P. preparations, besides those given, are Aloin, dose \ to 2 
grains (0.03-0.12); the Decoctum Aloes Comp ostium, dose \ to 2 
ounces (16.0-64.0) ; and the extracts, Extractum Aloes Socotrinoe and 
the Extr actum Aloes Barbadensis, the dose of each of which is 2 to 
6 grains (0.1-0.3). Enema Aloes, given in the dose of 10 ounces 
(320.0), is composed of aloes 40 grains (2.65), carbonate of potassium 
15 grains (1.0), and mucilage of starch 10 fluidounces (320.0). 

ALUM. 

Alum (Alumen, U. S. and B. P.) is the sulphate of aluminum and 
potassium in the JJ. S. P., but in the B. P. both it and the sulphate 
of aluminum and ammonium crystallized from a watery solution are 
official. At present much of the alum of commerce is made in the manu- 
facture of coal-gas for illuminating purposes, and it is therefore very 
cheap. It occurs in the form of octahedral crystals, and has an astrin- 
gent taste and acid reaction. After the crystals are exposed to the 
air for some time they become covered with a white coating. 

Physiological Action. — When alum is brought in contact with a 
mucous membrane it produces whitening, constriction, and puckering 
of the part, and applied to the skin thickens and toughens it by 
means of its astringent action. In either case it decreases secretion 
and causes contraction of the local blood-vessels and capillaries. 
Large amounts given for any length of time seem to increase secre- 
tion. Very large amounts are necessary to produce death. As much 
as two ounces will not kill a sickly dog. This is largely due to the 
fact that the vomiting and purging rids the animal of the drug, for 
if vomiting is prevented death rapidly ensues from gastro-enteritis. 
Injected into the blood, alum produces embolism and thrombosis. 

Therapeutics. — Alum is used at present in a number of diseases, 
chiefly as a local application. In cases of ordinary sore throat appli- 
cations of a strong solution (20 grains to the ounce of water — 1.3- 
32.0) on a swab will be found very useful. It is a valuable gargle in 
this condition, but ought not to be used, because of its destructive 
action on the teeth. In hemorrhage, when the leaking blood-vessels 
can be directly reached, alum is a remarkable haemostatic, aiding in 
the arrest of the bleeding in three ways — namely, by coagulating the 
albumin, by constringing the parts, and by crystallizing when applied 
in large amounts on lint, and thereby affording a surface which is 
rough and aids coagulation. In hemorrhage after tooth-extraction 
its application is a very useful treatment. Dissolved in water or 
alcohol, 2 grains to the ounce (0.1 to 32.0), it makes an exceedingly 
efficient application for sponging in night-sweats or localized sweat- 
ing of the feet or hands. In conjunctivitis as a lotion alum may be 
employed in a solution of 1 to 3 grains to the ounce (0.05-0.15 to 
32.0) of water for a child, or in the form of alum curd, made by 
adding powdered alum to milk or white of egg until a curd is formed, 
which is then applied to the eye every few hours or oftener. This 



58 DRUGS. 

is often useful in ecchymosis of the eyelid, or " black-eye," to pre- 
vent much exudation and discoloration. In cases where granular 
conjunctivitis occurs the use of the alum crystal or stick is some- 
times very useful, the lid being lifted and the alum passed lightly 
over it. Should there be inflammation of the cornea, alum should 
not be used, as it tends to produce ulceration of this part of 
the eye. In haemoptysis a fine spray of a strong solution of alum, 
20 grains to the ounce (1.3-32.0), may be employed, the necessity 
of the spray being made very fine being constantly borne in mind. 
This method may also be resorted to in bronchorrhoea or chronic 
bronchitis with excessive secretion, and in chronic catarrh of the 
pharynx and larynx. In mercurial ptyalism the drug may be used 
on a swab. Bathing the parts affected with an alum solution is 
said to be an efficient remedy in chilblains, and even for pruritus 
vulvce. As a vaginal wash for excessive leucorrhoea, in the strength 
of from 10 to 20 grains to the ounce (0.65-1.3 to 32.0) of water, alum 
is of value. Some observers claim good results from its use in diph- 
theria and tonsillitis. In follicular tonsillitis the alum-stick may be 
deeply inserted into the depressed follicles or applied to the swollen 
surface of the gland. In ingrowing toe-nail with granulations a piece 
of twisted absorbent cotton soaked in strong alum solution and 
inserted under the edge of the nail will in most instances do a great 
deal toward a cure. Dried alum (Alumen JExsiccatum, U. S. and B. 
P.) is useful as a dressing for old ulcers and sores, and has been 
highly recommended as an application for swollen gums where they 
press upon and override a tooth, particularly at the back of the jaw. 
The possibility of its exercising an evil effect on the teeth should not 
be forgotten Avhen this treatment is resorted to. 

Internally, alum has been used in diabetes, gastralgia, and dysen- 
tery of an acute and chronic type. In lead colic it seems to be of 
value in conjunction with morphine to allay the pain. At one time 
alum was largely employed in membranous croup in emetic dose for 
the dislodging of the membrane and for the astringent effect exer- 
cised as it was swallowed and expelled. 

The emetic dose of powdered alum is a heaping teaspoonful for a 
child or a tablespoonful for an adult. 

Alum may be used as an antidote in acute lead-poisoniug, as it is 
a soluble sulphate and also an emetic. 

G-lycerinum Aluminis (1 to 5) is official in the B. P., and is used 
as a local astringent application. 

AMBER. 

Succinum is derived from a fossil resin found in Prussia and 
Bohemia, and is used in the form of the oil {Oleum Succini), which 
is volatile, quite irritant, and obtained by destructive distillation from 
the deposits named. 

Therapeutics. — Oil of Amber is one of the best remedies for per- 
sistent hiccough that we have. It is very useful as a counter-irritant 
over rheumatic joints, and has been used in asthma, whooping cough, 



AMMONIA. 59 

and hysteria with good results. In the bronchitis of infants, with 
nervous disturbance, oil of amber in the proportion of 1 to 3 parts 
of olive oil applied to the back and front of the chest is of service. 
In adults suffering from acute laryngitis with an extension of the 
inflammation into the bronchial tubes full doses of sodium bromide 
given internally, with this proportion of amber oil and olive oil 
rubbed into the neck and chest, are very useful. The dose internally 
is 2 to 6 minims (0.1-0.3) given in emulsion. 



AMMONIA (NH 3 ). 

Ammonia is a gas of a very acrid, burning taste and sensation, 
capable of producing death very rapidly, when inhaled, by inflam- 
mation of the air-passages and the spasm of the glottis which ensues. 
It is made in large amounts in the manufacture of coal-gas. 

Physiological Action. — When ammonia comes in contact with the 
tissues of the body it acts as a most powerful irritant, causing a red- 
dening of the parts, followed, if the exposure be long enough, by 
local death and sloughing. If it be inhaled as a gas, it may produce 
rapid death by spasm or oedema of the glottis, or if a strong solution 
of it is swallowed, the same accident may occur. After more mod- 
erate inhalations severe bronchitis or pulmonary oedema may develop. 

Nervous System.- — If ammonia be injected into the blood of 
animals, violent convulsions at once ensue which are largely tetanic in 
type and depend upon a spinal action of the drug, since they are not 
stopped by division of the spinal cord, as they would be if the convul- 
sive movements had their origin in the brain. The drug in moderate 
amounts acts as a spinal excitant, increasing reflex action and all the 
evidences of spinal activity. If applied directly to a nerve, either 
motor or sensory, it paralyzes it, or if the drug be in very weak solu- 
tion, it seems to increase its functional activity. 

Circulation. — Upon the circulation ammonia acts as a very pow- 
erful but fleeting stimulant, increasing to a very great extent the 
pulse-rate, pulse-force, and arterial pressure. The cause of the 
increased pulse-rate depends upon stimulation of the accelerator nerves 
of the heart and of the heart itself, while the increase in force is due 
to the same cause, for Ringer and Sainsbury found the strength of 
the ventricles much increased. The rise of arterial pressure is due 
to the increased amount of blood pumped into the arteries by the 
stimulated heart, and probably by a stimulant action on the vaso- 
motor centre, although it is stated by some authorities that this is 
not so. As the drug acts as a stimulant on the respiratory centre, 
which is very near the vasomotor centre, it probably increases the 
functional activity of both. If by means of intravenous injection 
the ammonia reaches the heart in large amount, this organ ceases to 
beat at once, owing to paratysis of its muscular walls. 

The Blood. — In moderate amounts the drug has no effect on the 
blood, but when injected in poisonous quantities it causes the blood to 
fail to take up the oxygen, according to Feltz and Ritter. 



60 DRUGS. 

Respiration. — The injection of ammonia in moderate quantities 
into the blood causes an acceleration of the rate of respiration due to 
a stimulation of the respiratory centre, the respiratory movements 
becoming not only more full, but more rapid. If the drug is inhaled 
in small amounts, the same action is seen in a less degree; the changes 
both in breathing and circulation being partly due under such cir- 
cumstances to a reflex irritation transmitted along the sensory nerves. 

Elimination. — Ammonia when taken into the body is so extremely 
fleeting in its action that the question as to its escape from the system 
is of interest. If large amounts are taken, it is partly given off by 
the breath, but more of it is burnt up in the system, and, according to 
Bence Jones, eliminated as nitric acid by reason of its being oxidized 
in the body. Some think that it is in part excreted as urea. 

Therapeutics. — Ammonia is employed for four distinct purposes in 
medicine — namely, as a circulatory and respiratory stimulant, as a 
counter-irritant, and as an antacid. 

The indications for the use of ammonia in the first class of cases 
are all forms of sudden cardiac failure where there is no time or 
opportunity to use the more stable and slowly-acting drugs. These 
emergencies occur in snake-poisoning, in syncope from fright or other 
shock or indigestion, in sudden cardiac failure during the course of 
fevers and in pneumonia, and in all cases where rapid cardiac stim- 
ulation is needed. In the most pressing cases it should be injected 
directly into the vein of the leg, so as to act more quickly. If put 
into the subcutaneous tissues, it is almost certain to make a slough, 
and if injected into a vein of the arm, it may reach the heart in too 
concentrated form and cause cardiac depression. Ringer has found 
that the drug has the extraordinary power of causing a heart stopped 
or depressed by chloroform to return to its beating. 

In gastric acidity due to fermentation, with the development of 
abnormal acids, ammonia is the most active remedy we can employ, 
but is not to be given if acute irritation of the stomach exists. 

In prolonged diseases the employment of ammonia is not particu- 
larly advisable, owing to its fugacious action, although it is largely 
used, for the frequent administration necessarily required is apt to 
produce gastric disorder. Some persons claim that ammonia is useful 
as a sedative in drunkenness, but this is doubtful. 

Locally applied, strong ammonia-water may be used to produce a 
blister by placing a few drops on the skin under an inverted watch- 
glass. Ammonia-water may also be applied, often with great relief, 
to the spot stung by insects. The waters of ammonia are used exter- 
nally in stimulating liniments, and hypodermically when the drug is 
so given. The stronger water ought not to be employed for the latter 
purpose. The aromatic spirit is generally used internally in the dose 
of ^ drachm to 1 drachm (2.0-4.0), well diluted. This is also the 
dose of the ordinary spirit. 

Administration. — Ammonia is never employed in medicine as pure 
ammonia, but in the form of the stronger water ( Aqua Ammonias For- 
tior, U. S. ; Liquor Ammonice Fortior ', B. P.), containing 28 per cent, 
by weight of the gas, and the weaker water {Aqua Antmonice, U. S. ; 



AMMONIAC. 61 

Liquor Ammonia?, B. P.), which should contain about 10 per cent, 
by weight of the gas. The spirit of ammonia (Spiritus Ammonioe, 
TJ. S.) is given in the dose of 30 to 60 minims (2.0-4.0) in water, 
and the aromatic spirit of ammonia (Spiritus Ammonioe Aromaticus, 
TJ. S. and B. P.) in the dose of 25 to 60 minims (1.5-4.0) in water. 
The latter preparation is composed of carbonate of ammonium, the 
oils of pimenta, lemon, and lavender, with alcohol and ammonia-water. 
Spiritus Ammonioe Foetidus and Linimentum Ammonioe ( TJ. S.) are 
both official in the B. P. 



AMMONIAC. 

Ammoniac (Ammoniacum, TJ. S. and B. P.) is a resinous gum 
obtained from Dorema Ammoniacum, and is used very little in medi- 
cine at the present time. Internally and externally it produces some 
irritation when brought in contact with the tissues, and may be used 
internally in the dose of 10 to 30 grains (0.65-2.0) in pills in cases 
of chronic bronchitis devoid of any active inflammatory process. It 
is official in the form of the plaster of ammoniac and mercury (Em- 
plastrum Ammoniaci cum Hydrargyro, TJ. S. and B. P.), which is 
used as a stimulant over enlarged glands. Finally, there is the emul- 
sion of ammoniac (Emulsum Ammoniaci, TJ. S. and B. P.), used in 
chronic bronchitis in the dose of a tablespoonful (16.0). 



AMMONIUM (NH 4 ). 

The following salts of ammonium are official, and are used for 
various purposes : 

Acetate of Ammonium. 

Acetate of Ammonium is used in medicine in the form of the 
spirit of Mindererus (Liquor Ammonii Acetatis, TJ. S. and B. P.), 
dose 1 to 2 fluidrachms (4.0-8.0), for the purpose of acting as an 
antacid in gastric indigestion, and also as a mild diaphoretic which 
is inferior to sweet spirit of nitre. 

Benzoate of Ammonium. 

Benzoate of Ammonium (Ammonii Benzoas, TJ. S. and B. P.) is 
employed chiefly for its diuretic influences, which depend entirely 
upon the benzoic acid present in the compound. It should be kept 
in well-stoppered bottles. As benzoic acid is eliminated as hippuric 
acid and ammonia as nitric acid, this drug may be employed in cases 
where the physician desires to make the urine decidedly acid : as, for 
example, in patients suffering from catarrh of the bladder, when the 
urine is loaded with phosphates, which may be dissolved by this acid- 
ulation. The dose is 10 to 30 grains (0.6-2.0), which should be dis- 
solved in water or administered in cachets or capsules. 



62 DRUGS. 



Bromide of Ammonium. 

Bromide of Ammonium (Ammonii Bromidum, U. S. and B. P.) is 
really a crystalline salt, but is generally found in commerce as a white 
granular powder, which, when exposed to the atmosphere, becomes 
slightly yellowish. It is readily dissolved in water. 

Physiological Action. — Applied to the mucous membrane of the 
mouth, the bromide of ammonium produces a salty taste, is markedly 
pungent, and dissolves readily in the oral secretions. If large amounts 
are swallowed, it causes burning pain in the belly and evidences of 
gastro-enteritis. 

Nervous System. — The action of this drug upon this part of the 
body is its most important effect. Given to the lower animals, it pro- 
duces in frogs total loss of reflex activity, preceded, it is said, in some 
cases by tetanic convulsions, although no such motor disturbances may 
take place. In a series of studies undertaken by the writer to deter- 
mine the exact effect of the drug it was found that the spinal cord was 
depressed, both on its motor and sensory sides, while the nerves and 
muscles escaped. These results are in accord with those of other 
investigators, who also found that the nerves are unaffected. On the 
cerebral cortex it acts as a very distinct sedative. 

Circulation. — Upon the circulation bromide of ammonium acts 
as a stimulant in small doses, but as a cardiac paralyzant if a large 
amount comes in contact with the heart. In medicinal dose it is 
distinctly stimulant to the circulation, but not sufficiently so to render 
it valuable as a circulatory stimulant, to the exclusion of other more 
powerful preparations. 

Therapeutics. — The bromide of ammonium may be used in nearly 
every instance where bromide of potassium may be employed, and 
possesses the distinct advantage of being less depressant to the gen- 
eral system than the latter drug. It is, however, more apt to disorder 
the stomach even if given in moderate doses. In epilepsy it would 
seem to be of as much value as the potassium salt, and may be com- 
bined with it in some cases with success. (See article on Epilepsy, 
Part IV.) According to DaCosta, the drug is of very distinct value 
in rheumatism in the dose of 60 to 80 grains (4.0-5.3) a day, well 
diluted with water, although its manner of action in this disease is 
not known. The usual dose is 10 to 30 grains (0.65-2.0). It is 
incompatible with spirit of nitrous ether. 



Carbonate of Ammonium. 

Carbonate of Ammonium (Ammonii Carbonas, U. S. and B. JP.) 
undoubtedly has an action exactly like that of the liquid preparations 
of ammonia, and is used either alone or with the chloride in the 
treatment of bronchitis, particularly when this disease occurs in babies 
and young children. It is also largely employed by surgeons in the 
treatment of children after a surgical operation to overcome the 
respiratory and circulatory depression produced by the anaesthetic. 



AMMONIUM. 63 

The dose is 2 to 10 grains (0.1-0.65) in syrup of acacia and water. 
It is a rapidly-acting cardiac and respiratory stimulant. 

R. Ammonii carbonat gr. xlviij (3.0). 

Syrup, acacise . <. f^j (32.0). 

Aquse dest q. s. ad f.^iij (96.0). — M. 

S. — Teaspoonful (4.0) every two hours for a child of three or four years. 

Chloride of Ammonium. 

The Chloride or Muriate of Ammonium [Ammonii Chloridum, TJ. S. 
and B. P.) has an entirely different action and therapeutic use from 
the rest of this group. It possesses almost no influence over the heart 
and respiration, but does exercise a very stimulant effect on mucous 
membranes, increasing the secretion of mucus. The consideration of 
its use in diseases of the lungs can be found in the articles on Pneu- 
monia and Bronchitis. Chloride-of-ammonium fumes can be obtained 
from a few grains of the drug heated in an iron spoon over a gas-jet 
or by means of a set of three wash-bottles. In one of these is placed 
stronger water of ammonia, in the other muriatic acid. Each of these 
is connected with a third bottle by means of glass tubing, this bottle 
being partly filled with water, through which the fumes in passing 
become purified and form the fumes of chloride of ammonium. The 
drug may also be used in a spray from an atomizer. It has been 
employed in intermittent fever, but has gone out of use, and has also 
been used in neuralgias of the ovarian type by Goodell and others. 
In the treatment of chronic torpor of the liver and subacute hepatitis, 
and even in cirrhosis and hepatic abscess, it has been thought of value. 
Many clinicians have found it useful in the treatment of the gastric 
and intestinal catarrhs of children of a very subacute type, and it is 
the routine treatment for all such cases which come under observation 
at the hospitals and elsewhere where the author has charge. The 
dose is 2 to 15 grains (0.1-1.0), preferably given with liquorice and 
water to mask the taste. 

R. Ammonii chloridi ^ij (8.0). 

Extract glycyrrhiz flj (32.0). 

Aquas dest q. s. ad f giij (96.0).— M. 

S. — Teaspoonful (4.0) t. d. after meals for a child of five to ten years. 

The chloride of ammonium may, however, be given in compressed 
pills, provided a large draught of water or milk is taken simulta- 
neously to protect the stomach. (See article on Bronchitis for other 
prescriptions,) 

Gillespie asserts that 10 grains (0.65) of chloride of ammonium 
given half an hour before meals gives extraordinary relief in painful 
■dyspepsia, due to hyperacidity of the stomach. 

Iodide of Ammonium. 

Iodide of Ammonium {Ammonii Iodidum, U. S.) should be kept 
in dark, well-stoppered bottles, and if deeply colored should not be 
dispensed. It may be employed in the close of 2 to 5 grains (0.1-0.3) 
in all cases where the iodide of potassium is indicated, and seems to 



64 DRUGS. 

possess alterative influences equal to those of that salt. It has been 
recommended as a local application in cases of enlarged tonsils in the 
form of a solution of 30 grains (2.0) of the salt to the ounce (32.0) 
of glycerin, particularly if struma is the cause of the enlargement. 
The application is to be made once a day with a swab or camel's- 
hair brush. It is necessary that this solution be not exposed to the 
air or it will undergo decomposition. 

Valerianate of Ammonium. 

Valerianate of Ammonium (Ammonii Valerianas, U. S.) is the 
salt of ammonium commonly used in the nervous unrest of pregnant 
or hysterical women, or at the menopause in the peculiar nervous dis- 
orders apt to occur at that period. In poisonous doses it paralyzes 
the spinal cord in the lower animals. It is usually given in the form 
of the elixir of valerianate of ammonium, the dose of which is a tea- 
spoonful to a dessertspoonful, or it is combined with the bromides, 
under which circumstances it is much more efficacious. The dose of 
the salt itself is 10 to 15 grains (0.65-1.0). 

The sulphate of ammonium is never used in medicine. The phos- 
phate of ammonium is employed in rheumatism in the dose of 10 to 
20 grains (0.65-1.3). It is no longer official. 

The B. P. preparations besides those already given are : Sulphide 
of Ammonium, Oxalate of Ammonium, Liquor Ammonii Citratis, dose 
2 to 6 fluidrachms (8.0-24.0); Liquor Ammonii Citratis Fortior, dose 
30 minims to 2 fluidrachms (2.0-8.0); Liquor Ammonii Ac etatis For- 
tior, dose 25 to 75 minims (1.6-5.0). 

AMYL NITRITE. 

Amyl Nitrite (Amyl Nitris, U. S. and B. P.) is a very volatile, 
somewhat oily liquid possessing a peculiar penetrating pear-like odor. 
It is made by the action of nitric and nitrous acids upon amylic alco- 
hol, and is not to be confounded with nitrate of amyl, which has a 
different physiological action and is never used medicinally. 

Nitrite of amyl should be protected from light, heat, and fire. 

Physiological Action. — When swallowed or inhaled the drug pro- 
duces staggering, fulness in the head, roaring in the ears, duskiness 
of the face, and finally utter muscular relaxation, so that the animal 
or man falls to the ground. The heart beats very rapidly and forci- 
bly, and the respiration becomes gasping. 

Nervous System. — Nitrite of amyl acts as the most rapid of all 
the nervous depressants and sedatives known, except prussic acid. 
Experiments show that its dominant action is on the motor side of 
the spinal cord. The motor cortex of the brain and the motor nerves 
are only affected by large amounts. Upon the nervous apparatus of 
sensation nitrite of amyl has no effect in medicinal amounts, and can 
never be used to relieve pain unless it be due to spasm or to angina 
pectoris. The muscles are depressed by toxic amounts. 

Circulation. — When nitrite of amyl is used the pulse becomes 



AMYL NITRITE. 65 

exceedingly rapid, while the arterial tension progressively falls. The 
increase in pulse-rate is due to depression of the centric inhibitory 
apparatus of the heart and to the sudden relaxation of the blood- 
vessels, by reason of which, the resistance being taken away, the 
heart beats faster. The fall of arterial pressure is due to depres- 
sion of the vasomotor centres and the muscular coats of the blood- 
vessels. In very small amounts the drug stimulates the heart-muscle 
(Reichert), but its dominant action is that of a depressant. 

The Blood. — In medicinal dose this drug produces a chocolate 
color of the arterial blood, due to the change of oxy haemoglobin into 
methaemoglobin. 

Urine and Elimination. — The urine sometimes contains sugar 
after the use of the nitrite of amyl, and there is increased diuresis. 
The drug is eliminated very rapidly from the body by the lungs and 
kidneys. 

Temperature. — If the nitrite of amyl be employed for any 
length of time, a most remarkable fall in bodily temperature ensues, 
which is probably due to diminished oxidation, but possibly to some 
effect on the heat-centres governing heat-production and dissipation. 
The vascular dilatation also greatly tends to aid in the fall of bodily 
heat produced by the drug. 

Therapeutics. — Nitrite of amyl is used to relax general or local 
muscular spasms, for the relaxation of the spasm of epilepsy and for 
aborting an on-coming fit, for the prevention and subjugation of strych- 
nine convulsions and tetanus, and for the relief of angina pectoris, 
provided the attack is accompanied by high arterial tension. It may 
be used in puerperal eclampsia, but it is a dangerous remedy, because 
of its relaxation of the uterus and the consequent danger of post- 
partum hemorrhage. In dysmenorrhoea with uterine spasm it often 
gives great relief. Nitrite of an^l has been used in cases of sea-sick- 
ness as a prophylactic and cure with considerable success. In cardiac 
failure from fright or anaesthetics amyl nitrite is often of great value 
in single whiffs. If it does not act at once under these circumstancs, 
it is worse than useless to push it. It has also been found of value 
in whooping cough, laryngismus stridulus, asthma, spasmodic croup, 
and infantile convulsions. In migraine with local vasomotor spasm 
and true hemianopsia it is very useful. In strychnine poisoning and 
tetanus it must be used between the spasms or else given hypodermic- 
ally, as the respiratory cramp prevents its inhalation. 

Administration. — The drug may be given by placing three to five 
drops on a handkerchief and inhaling the fumes, or it may be dropped 
on sugar and taken by the mouth in the same quantity. 

It is important to remember the fact that the effects of the drug 
are more severe for a moment after its use than during its inhalation. 
The physician should warn the patient that the effect of the drug 
is sudden and alarming, and in nervous cases should direct that the 
inhalations be made gently, as a very fall inhalation may produce 
unpleasant sensations of cardiac failure. 

The best way for patients to use the drug is to have it in pearls 
of glass, each holding 3 minims (0.15). One or more of these may 



66 DRUGS. 

be crushed in the handkerchief and the fumes inhaled. Some of the 
pearls made by careless manufacturers are of such thick, strong glass 
that they are difficult to break, and if broken are apt to cut the lin- 
gers. These are, of course, to be avoided. 



ANTHRAROBIN. 

Anthrarobin, which Avas originally discovered by Liebermann, 
seems to possess equal value with its relative chrysarobin, and to be 
capable of acting as efficaciously as this substance in the treatment 
of skin diseases. It is a yellowish powder, tolerably stable in a dry 
atmosphere, not soluble in acids or water, but readily soluble in dilute 
alkaline solution or alcohol, at first making a solution of a brown 
color, which, as oxygen is taken up, passes to a green and finally to 
a violet. 

Therapeutically, anthrarobin has been employed by Rosenthal and 
by Behrend, and more recently Kobner has recorded his experience 
with it, employing it with good results in a 10 to 20 per cent, solu- 
tion in the various forms of tonsurans as a wash. Rosenthal has used 
it in 'psoriasis and pityriasis versicolor and herpes, and Behrend asserts 
that it is often better in its effects upon the skin than chrysarobin, as 
it produces less inflammation and only discolors the skin slightly. It 
also possesses the additional value of making so slight a stain on the 
linen that it can be removed by washing. 

According to most authorities, it is best to keep the drug in alco- 
holic solution, and, if the bottle is well corked, such a mixture 
remains good for a week. 

ANTIMONY. 

Antimony itself is rarely used in medicine, owing to its insolubil- 
ity, but is generally employed as the tartrate of antimony and potas- 
sium, or Tartar Emetic {Antimonii et Potassii Tartras, TJ. S. ; Anti- 
monium Tartaratum, B. P.), or in the form of the sulphide {Anti- 
monii Sulphidum, TJ. S.); purified sulphide {Antimonii Sulphidum 
Purificatum, TJ. S. ; Antimonium Nigrum Purification, B. P.) ; and 
sulphurated antimony {Antimonium Sulphuratum, TJ. S. and B. P.), 
sometimes called Kermes Mineral. The last three drugs are very 
rarely employed, and are unreliable preparations, although some prac- 
titioners use kermes mineral as an alterative circulatory depressant 
and sedative expectorant in the dose of jr grain (0.01) every hour or 
two. As an emetic the dose of Kermes mineral is 1 to 4 grains (0.05- 
0.2). 

The oxide of antimony {Antimonii Oxidum, TJ. S.) forms part of 
the Pulvis Aromaticus. 



Tartar Emetic. 

Tartar Emetic {Antimonii et Potassii Tartras, TJ. S. ; Antimonium 
Tartaratum, B. P.) is made by boiling the oxide of antimony with 



ANTIMONY. 67 

bitartrate of potassium and water. Although it is really crystalline, 
it is generally sold as a fine powder, owing to these crystals being 
easily pulverized. It is insoluble in absolute alcohol, but is soluble 
in ordinary water, and still more so in boiling water. In dilute alco- 
hol it is partly soluble. 

Owing to its chemical constitution tartar emetic should never be 
given with either acids or alkalies, and all drugs containing tannic 
acid are also incompatible with it, owing to the fact that an insoluble 
tannate is rapidly formed, which is absorbed very slowly if at all. 
So complete is the insolubility of the compound so formed that tan- 
nic acid is the best antidote to the drug that we possess. 

Physiological Action. — Tartar emetic, when applied to mucous 
membranes, produces a burning sensation, and upon the skin it may 
readily cause a large amount of irritation if the part be delicate. If 
kept in contact with a mucous membrane, very distinct inflammatory 
changes occur, and if it be applied to the skin for any length of time, 
redness, followed by acne of a pustular character, appears, which 
finally ends in ulceration and sloughing if the use of the drug is 
persisted in. Under these circumstances the vitality of the parts 
seems interfered with, and, as a result, healing takes place very slowly 
indeed. 

Nervous System. — Antimony is a depressant to the sensory side 
of the spinal cord and a paralyzant to all the spinal centres, motor 
and sensory, in poisonous dose. 

It is stated that when an animal is under its influence sensation to 
heat and acids is lost before the ordinary sense of touch is destroyed. 
The convulsions which sometimes ensue after poisonous doses in the 
lower animals are due to anaemia of the brain brought on by the cir- 
culatory depression. Ringer and Murrell have proved antimony to 
be a motor-nerve and muscle poison. 

Circulation. — The chief influence of antimony is exerted upon 
the circulation. In small doses it lowers the pulse-rate by a direct 
depression of the heart-muscle, and simultaneously decreases arterial 
tension by an action upon the peripheral portions of the vasomotor 
system in the walls of the blood-vessels, but the vasomotor influences 
may be in part centric, and this question must be considered as sub 
judice. The fall of arterial pressure is also due to failure of heart- 
force. With the lowering of the pulse-rate there is nearly always a 
corresponding decrease in cardiac power. 

When poisonous doses are employed, death ensues after great cir- 
culatory and respiratory depression, as will be seen below. The heart 
is found relaxed and flabby and utterly dead to all stimuli, although, 
if the dose has not been very excessive and digitalis is freely employed, 
the heart may be made to beat again ; this is at least true in the frog. 
The drug in poisonous doses is thought to depress the peripheral ends 
of the vagus nerves. 

Respiration. — The drug has little or no effect upon respiration 
except when given in lethal doses. Under these circumstances death 
is produced in three ways, all of them acting together. Primarily, 
the respiratory centre in the medulla is depressed, and the governing 



68 DRUGS. 

nerves of breathing, the pneumogastrics, are also rendered inactive ; 
secondarily, the cardiac failure readily causes pulmonary congestion ; 
and, thirdly, the drug causes such an outpouring of liquid and mucus 
into the bronchial tubes that the patient is drowned in his own secre- 
tion, which he is too weak to expel. 

Stomach and Intestines. — Antimony in toxic doses is a power- 
ful irritant to these portions of the body. In full medicinal amounts 
it acts as a slow but powerful emetic, producing much nausea. The 
vomiting is due to an action on the vomiting centre in the medulla 
and to a direct action on the stomach itself. The drug is, therefore, 
a centric and peripheral emetic. 

Very full doses produce watery purging, attended with some grip- 
ing and tenesmus. 

Elimination. — Antimony escapes from the body in all the secre- 
tions, but largely by the bowels. The latter method of elimination 
seems chiefly to follow poisonous doses, and purging is an effort at 
elimination. 

Poisoning. — When toxic doses of tartar emetic are taken, the pulse 
at first becomes slightly weaker' and slower, the skin becomes moist and 
relaxed, a general sense of relaxation comes on, and simultaneously a 
sensation of severe nausea and gastric distress appears. 

Following this condition violent vomiting asserts itself. The 
ejected mass consists of the contents of the stomach — mucus, bile, and 
watery fluids, and perhaps blood. Purging appears almost as early 
as the vomiting, and consists first of the normal contents of the intes- 
tines, then mucus, then bile, and, very rarely, blood. These signs 
may rapidly pass away and the characteristic peculiar "rice-water" 
stools l of antimonial poisoning appear. The general condition of 
the patient is now most serious. The face is pinched, livid, and cov- 
ered with a cold sweat. The pulse is rapid and shuttle-like — to and 
fro — or lost at the wrist ; the arterial tension is almost nil. The res- 
pirations are faint and fluttering, and so shallow as hardly to be seen 
or heard. Cramps in the calves of the legs attack the patient, due 
to the abstraction of water from the tissues by the violent purging, 
and the temperature falls lower and lower as death approaches. The 
general condition is such that all the signs point to Asiatic cholera, 
and antimonial poisoning cannot be separated from this disease during 
an epidemic without a history of the case or a chemical analysis of 
the secretions, which ought always to be preserved. 2 

The treatment of antimonial poisoning consists in the internal ad- 
ministration of large amounts of tannic acid, in the use of the stomach- 
pump, and in the maintenance of an absolutely prone position. The 
patient should vomit into towels and not raise the head from the 
ground; the head, indeed, should generally be placed lower than the 

1 A c: rice-water " stool is one which, on standing in a glass, separates into two lay- 
ers, the lower white and flocculent, the upper watery and almost clear. 

2 This is a good opportunity to state that the secretions and excretions of a person 
dying of any poison should be placed in a chemically-clean jar capable of being sealed 
tight. The same rule of cleanliness applies to the jars holding organs at the post- 
mortem. The jars should be ready, and no intermediate vessel used. They should 
be sealed at once, and kept so until claimed by the authorities. 



ANTIMONY. 69 

heels. External heat, alcohol, and digitalis should be used thor- 
oughly, and opium should be employed hypodermically to allay pain 
and irritation, unless the respirations are too feeble. 

Fatty degeneration of the tissues may occur after acute antimonial 
poisoning. 

Therapeutics. — Tartar emetic is employed for at least five separate 
purposes, the most usual of which is as a circulatory quieter and seda- 
tive. The indications for antimony as a circulatory depressant are not 
so generally recognized at present as they were at one time, on account 
of the introduction of other drugs. Suffice it to state that all states of 
sthenic inflammation with a bounding pulse, high fever, and symptoms 
showing the patient to be possessed of robust constitution permit of its 
use, while ail asthenic conditions most emphatically contraindicate 
its employment. In the treatment of colds, to break forming diseases, 
and to allay inflammation it is given in moderate close. It is useful 
in sthenic bronchitis as an expectorant. Under these circumstances 
it may be given in emetic dose ; or, if emesis is not desirable, minute 
amounts given hourly are of value, such as -^ of a grain (0.001) 
every hour, or a teaspoonful of a solution of 1 grain (0.05) to \ a 
pint (250 cc.) every hour may be used. This is a particularly useful 
merhod in children, as the solution is tasteless and it does not pro- 
duce nausea and vomiting. 

In the acute catarrh of children, which affects the stomach and 
entire alimentary canal and is associated with little fever, the use of 
the drug is extremely valuable, and often aborts an attack when given 
in the same dose as just described. 

As an emetic antimony is slow but forcible, and it ought not to be 
used in poisoning, owing to its slowness. 

Before the introduction of anaesthetics emetic doses were employed 
to relax the muscles in reducing dislocations and fractures. 

Tartar emetic is harmful if irritation of the stomach is present or 
if kidney changes are rapidly progressing. If one good-sized emetic 
dose is not sufficient to produce vomiting, it should not be repeated, 
but some other emetic or the stomach-pump be used, lest antimonial 
poisoning complicate the case. The emetic dose must be large enough 
to be effective, or none at all should be given. If this rule is dis- 
obeyed, systemic changes come on with undesirable severity in those 
cases where emesis fails to occur because of small doses. 

As a counter-irritant antimony is employed in the form of an oint- 
ment whenever a very slowly acting and prolonged counter-irritation 
is to be maintained, as on the back of the neck in epilepsy or similar 
chronic states, and in old enlargements of the joints. 

Antimony acts well as a diaphoretic, but its use is undesirable, 
owing to its disagreeable effects, such as nausea and intestinal dis- 
turbance, and because other, more pleasant, drugs act equally well. 

Administration. — The dose of tartar emetic when there is an 
excited circulation is -^ to y 1 ^ of a grain (0.003-0.006) every three 
hours until an effect is obtained. As an emetic the dose is \ to 1 
grain (0.03-0.06). The wine of antimony ( Vinum Antimonii, XI. S. ; 
Vinum Antimoniale, B. P.) contains only 2 grains of tartar emetic 



70 DRUGS. 

to each ounce, and may be used in the dose of ^ to 1 teaspoonful 
(2.0-4.0), or, as an emetic, in the dose of 1 to 2 tablespoonfuls (15.0- 
30.0). The compound pill of antimony {Pilulce. Antimonii Composite, 
TJ. S., or Plummer's pill) is used as an alterative, and contains sul- 
phurated antimony l a grain (0.03), calomel ^ a grain (0.03), guaiac 
1 grain (0.06), and tragacanth ; the dose is one to three pills. 

The ointment of antimony ( Unguentum Antimonii Tartarati,B. P.) 
is used externally as a counter-irritant spread on a rag or piece of lint. 
Antimonial powder (Pulvis Antimonialis, TJ. S. and B. P.), or James's 
powder, contains oxide of antimony and phosphate of calcium, and is 
given occasionally as an antipyretic in the treatment of rheumatism 
and fever in the dose of 3 to 10 grains (0.15-0.65); it is best given 
in a pill. 

The compound syrup of squill (Syrupus Scillce Compositus, TJ. #.), 
otherwise known as " Coxe's hive syrup," contains three-fourths of 
a grain (0.045) of tartar emetic to the ounce. The dose is 20 to 30 
drops (1.3-2.0) for an adult as a sedative, or from this amount to 1 
drachm to a child as an emetic. Liquor Antimonii Chloridi, B. P., 
is not official in this country, and in England is rarely used as an 
escharotic. 

ANTIPYRINE. 

Antipyrine is a derivative of coal-tar, its chemical name being 
phenyldimethylpyrazolon. It is also called Phenozone (B. P.). In 
appearance it is a white powder of a somewhat bitter taste, and is 
very soluble in water, less so in ether, alcohol, and chloroform. 

When antipyrine is given to a man in full medicinal amount, it 
causes a buzzing and tightness of the head not unlike that produced 
by quinine. The bodily temperature, if normal, is depressed a frac- 
tion of a degree, but no other symptoms are manifested. If the dose 
be quite large, some blueness of the lips and finger-nails appears, 
chilly sensations are experienced, and finally a profuse sweat breaks 
out over the entire body, which is more severe if fever has previously 
existed. Large doses sometimes cause nausea and vomiting. 

Physiological Action. — Nebvous System. — When a poisonous dose 
of antipyrine is given to one of the lower animals, relaxation, utter 
loss of reflex action, and total inability to move come on at once, and 
death ensues. Somewhat smaller doses produce exceedingly severe 
tetanic and epileptiform convulsions, but consciousness seems to be 
preserved. It has been proved that the chief cause of the convul- 
sion is an action of the drug on the brain. 1 Very large toxic doses, 
therefore, decrease reflex action, and smaller ones increase it, though 
medicinal amounts certainly lessen reflex activity to a notable degree. 
The cause of this failure of reflexes is depression of the sensory 
nerves and the receptive centres of the spinal cord. Medicinal 
amounts must, therefore, be regarded as very distinct nervous seda- 
tives, acting much more actively on the nerves of sensation than on 
those of motion. Applied beneath the skin or to a mucous mem- 
1 See author's Boylston Prize Essay on Antipyretics. Philadelphia, 1891. 



ANTIPYRINE. 71 

brane, antipyrine is a powerful local anaesthetic, the anaesthesia last- 
ing often for several days. 

Circulation. — The studies of a very large number of pharma- 
cologists prove most conclusively that antipyrine has no effect on the 
circulation of the lower animals in moderate doses unless these be so 
frequently repeated that cumulative effects ensue. Many reliable 
clinical observers have asserted that the drug depresses the circula- 
tion in man in some cases, and antipyrine is certainly not a cardiac 
stimulant. The writer is confident, however, that antipyrine is not so 
distinctly a cardiac depressant as some think. Large, poisonous doses 
lower blood-pressure, unless convulsions are present, when the pressure 
is raised. The action of the drug on the circulation is nevertheless a 
very unimportant part of its power, and in most cases is not to be 
considered in the treatment of disease unless the circulation is feeble. 
In many of the cases where vascular depression and collapse have 
followed its use it has been employed in excessive amounts, or the 
fall in bodily temperature has caused the untoward symptoms. (See 
Fever and its Treatment,) 

Blood. — No spectroscopic changes in the blood follow the use of 
medicinal doses of antipyrine in the ordinary individual, but in poi- 
sonous amounts it produces methaemoglobin. If the doses be toxic 
or idiosyncrasy exists, cyanosis may come on. That the blood is not 
destroyed by small amounts is proved by the absence of haematin in 
the urine of persons taking the drug. The corpuscles suffer no 
changes except in very pronounced poisoning, when they are said in 
become crenated and shrivelled. 

Respiration. — When antipyrine is given in lethal doses, death 
results from failure of the respiratory centre. Ordinary doses have 
no effect on this function, but large ones make the breathing more 
rapid. 

Temperature. — In normal men and animals antipyrine in medi- 
cinal dose may be considered as without effect so far as bodily tempera- 
ture is concerned. In fevered animals it has been found to lower 
temperature by decreasing heat-production and increasing heat-dissi- 
pation. That it does not do this by an action on the blood seems 
proved by the fact that the blood is not affected by medicinal amounts. 
The sweating does not cause the fall, since it takes place when no 
sweating occurs. It may, therefore, be considered that the drug 
directly affects the nervous heat-mechanism of the body. 

Kidneys, Tissue-waste, and Urine. — A large number of studies 
made upon man and the lower animals by competent investigators 
have brought about very considerable advances in our knowledge of 
the influence of antipyrine upon tissue-waste. It is useless to burden 
this volume with a discussion of their methods and results, which may 
be found in the author's Essay on Antipyretics. Suffice it* to say that, 
while all observers are not agreed as to the effects produced, the deduc- 
tions apparently to be drawn are that the drug diminishes the quan- 
tity of the urine excreted, and also decreases the elimination of the 
results of nitrogenous tissue-metamorphosis — or, in other words, is a 
conservator of the tissues of the body. 



72 DRUGS. 

Elimination. — The elimination of antipyrine goes on very rap- 
idly indeed, and begins almost at once after its ingestion. Maragliano 
states that it appears in the urine in three hours after it is taken, so 
that at the fourth hour elimination is at its height, although it continues 
for twenty-four or perhaps thirty-six hours. According to Pavlinow, 
part of the antipyrine ingested is eliminated by the salivary glands. 

Poisoning. — The treatment of poisoning by antipyrine consists in 
the administration of stimulants, the maintenance of bodily heat, the 
use of atropine to restore the tone of the vascular system, and, if 
cyanosis is alarming, the employment of oxygen inhalations. 

Antiseptic Power. — Antipyrine exerts a very distinct antiseptic 
action in small amounts, delays all forms of fermentation, and destroys 
germs when it is present in large quantity. 

Therapeutics. — Antipyrine is employed in medicine for two great 
purposes — namely, for the reduction of fever and the relief of pain — 
but its employment as an antipyretic is now entirely surpassed by its 
use as an analgesic. 

As an antipyretic, antipyrine should be given in a few full doses 
rather than frequent small ones, as a general rule, since if the fever 
is of any severity the latter method of administering it Avill have no 
effect, and the constant dosing will produce gradual saturation of the 
system without causing a fall of temperature until too much is taken. 
On the other hand, too large doses may depress the temperature to a 
point below normal and induce collapse. In the article on Fevers 
(Part IV.) the conditions are indicated in which the drug is best em- 
ployed, these being the sthenic fevers as a rule, or instances where 
excessive outbursts of fever necessitate prompt reduction of temper- 
ature. Under these conditions antipyrine is the best adjunct to the 
cold bath. In excessively high temperature in pneumonia it may prove 
of great value, and in scarlet fever and smallpox antipyrine is of service 
in some instances, although in pneumonia, as a rule, the condition of 
the patient indicates the use of cold to the chest as a local measure for 
the reduction of congestion and to relieve fever. (See Pneumonia.) The 
use of the cold applications is always to be preferred to antipyrine in the 
reduction of fever, since they are safer, more reliable, and do not strain 
the kidneys, reduce the blood, or depress the heart in feeble patients. 
(See Cold and Fever.) When cold water cannot be used, then antipyrine 
may be used. If, however, the fever persists and becomes dangerously 
high, antipyrine may be used if the patient is robust. In phthisis anti- 
pyrine generally increases the sweating, produces oppression, and either 
fails to act as an antipyretic or produces collapse by exercising too great 
an effect. In sunstroke it frequently fails to influence the temperature. 

Be the fever what it may, provided it be associated with any dis- 
eased process, antipyrine is absolutely useless so far as any influence 
over the course of the disease itself is concerned. It is a remedy to 
be used in the treatment of symptoms, not in the removal of the cause 
of the fever. 

As an analgesic antipyrine is the peer of opium. Although the 
latter drug will relieve all forms of pain if it be pushed, it possesses 
many disadvantages not found in antipyrine. In deep-seated pains 



ANTIPYRINE. 73 

due to disease of the organs of the body, in inflammations and similar 
disturbances, antipyrine is useless. In neuralgic affections of all kinds it 
finds its sphere, particularly if the disorder be rheumatic, gouty, or due 
to nervous depression from nervous exhaustion or disease. Under the 
latter circumstances it is best combined with caffeine and a little bromide 
of potassium. (See Neuralgia.) In rheumatism it will give relief in a 
fairly large number of cases, not only relieving the pain and fever if 
they be present, but also actually modifying the disease. It seems, 
however, to increase sweating in acute articular rheumatism. In gout 
it is stated to have a specific curative effect upon the disease over and 
above the relief of the pain, but this is doubtful. Its use in dysmenor- 
rhoea has been recommended, but its beneficial influence in such cases 
is doubtful. At one time it was thought that its use would relieve 
the pains of labor entirely, but this has, unfortunately, proved untrue. 
It may, however, be tried, when the suffering is very severe, in the 
dose of 15 grains (1.0). In the severe lancinating or darting pains 
of locomotor ataxia, and in the laryngeal and gastric crises compli- 
cating this disease, antipyrine is an invaluable and reliable remedy. 
Curiously enough, it seems to subdue acute attacks of pain in poste- 
rior sclerosis, but fails to control the slighter pains and muscular 
twitchings sometimes seen in this disease and in myelitis. 

Some clinicians have used antipyrine with asserted great success 
in diabetes mellitus. In such instances the disease often depends on 
a gouty diathesis, and can be well relieved by salicylates. Antipyrine 
may be used hypodermically in the region of a hypersensitive nerve as 
a local anaesthetic. The anaesthesia produced by it lasts for several 
days, but the pain immediately after the injection is severe. 

Antipyrine is a very useful remedy in epilepsy. (See Epilepsy.) 

In ivhooving cough antipyrine has given relief more frequently in 
the writer's experience than any other remedy. It should be given 
to a child of five years in the dose of 2 grains (0.1) every four or five 
hours, the patient being watched for cyanosis and the drug stopped 
as soon as this symptom appears. Antipyrine generally decreases 
the frequency rather than the severity of the attacks of cough. 

In malarial diseases antipyrine certainly exercises no antiperiodic 
influence, although it controls the febrile paroxysms to a great extent. 
Yet, while this is the opinion of the majority of those who have used 
it, it cannot be said that every observer has reached similar conclu- 
sions. Potter reports cases where the results obtained from its use 
were most satisfactory, particularly in the intermittent form of mala- 
rial poisoning. One cannot help thinking that frequently w T here anti- 
pyrine has been reported as acting as an antiperiodic it has simply 
lowered the fever, and so seemed to affect the disease. 

Antipyrine very distinctly increases susceptibility of patients to 
taking cold, and ought not to be employed by those who are forced to 
go out of doors in cold weather. In acute coryza the temporary 
relief produced by applying cocaine to the engorged Schneiderian 
membrane may be prolonged indefinitely by the use of a spray of 
antipyrine in the strength of 4 per cent. This produces a smarting 
sensation, which speedily passes away. The same treatment is of 



74 DRUGS. 

value in inflammations of the larynx and pharynx. Should cocaine 
solutions not precede the antipyrine, the primary irritant effects per- 
sist unless the strength of the solution of antipyrine is reduced to 1 
or 2 per cent. It is always best to precede its use by cocaine. 

Untoward Effects. — Aside from the results of poisonous doses, a 
large number of cases present slight cyanosis or duskiness of the 
hands and of the face about the nose and lips ; the fingers may be 
cold and clammy, and the feet are often very cold; sweating is a 
very common symptom of the untoward influence of antipyrine, and 
pricking or tingling of the skin is not uncommonly seen. By far the 
largest number of these cases, however, suffer from disorders associ- 
ated with the skin, and erythematous patches may be seen every- 
where, more particularly on the hands and feet and about the face, 
arms, and chest. Occasionally pemphigus-like spots appear, and 
often large bullae have been noted as present. Elsewhere are pub- 
lished the statistics, collected from medical literature, of 121 cases 
of untoward effects exercised by antipyrine. 1 An analysis of these 
shows that females were much more frequently affected than males, 
and that the most susceptible age Avas decidedly that of full adult life 
— namely, from thirty to forty years in both sexes. The dose caus- 
ing these effects was most commonly a moderate one — from 10 to 15 
grains (0.65-1.0), or even from 4 to 10 grains (0.2-0.65). This fact 
holds good with regard to both sexes. The time of onset of the 
symptoms varied somewhat, according to whether the drug was given 
in one excessive dose or in frequently-repeated medicinal doses. In 
many instances the appearance of the symptoms was sudden rather 
than gradual. As a rule, the duration of the symptoms did not 
exceed one to three hours, three days being the longest time men- 
tioned. It is interesting to note, however, that of all these cases only 
six proved fatal, and in these there was ample cause for death aside 
from any effect of the drug. We can rest assured, therefore, in ordi- 
nary cases of disease that patients exhibiting untoward effects of anti- 
pyrine are not in any acute danger, although the symptoms may be 
temporarily most alarming. Typhoid fever seems, according to the 
statistics collected by the writer, to be the disease in which this unex- 
pected influence manifests itself most frequently, but this may be due 
to the fact that it is so common a malady and is so frequently treated 
by means of antipyretics. 

Administration. — Owing to the solubility of antipyrine, it is most 
readily given in a little water in a wineglass or spoon. If its slight 
taste is disliked, it may be dissolved in any one of the aromatic waters 
or in syrup of bitter orange-peel or some similar vehicle. Most per- 
sons prefer to take it with water. The amount which may be given at 
a dose is 5 to 20 grains (0.3-1.3), but 3 to 5 grains (0.3) is perhaps the 
best dose in most cases, at least until it is seen how well it is borne. 

Incompatibles. — When added to sweet spirit of nitre, antipyrine in 
the course of a few moments produces a blue, changing to a dark- 
green, color, owing to the formation of iso-nitroso-antipyrine, which 
is not poisonous, but when in the form of a dry powder is readily 
1 See author's Essay on Antipyretics. Philadelphia, 1891. 



APOMORPHINE. 75 

oxidized on exposure to slight heat. If this color is not formed, the 
spirit of nitre lacks its nitrous ether and is worthless, so that we have 
not only another incompatibility to remember, but a new means of 
testing the therapeutic value of all samples of sweet spirit of nitre 
which may be dispensed by druggists. Calomel and antipyrine have 
also been found to be incompatible. 



APIOL. 

Apiol is a yellowish oily liquid with a specific gravity greater 
than water, an acid taste, and curious odor. It is derived from com- 
mon parsley, or Petroselinum. So far as is known to the author, no 
careful study of its physiological action has ever been made, but two 
French observers, Joret and Homolle, state that in overdose it causes 
ringing in the ears, intoxication, and severe frontal headache. 

Therapeutics. — Originally introduced to combat malarial fevers, 
because of a fancied resemblance in its toxic action to quinine, apiol 
has at last found its true level as a remedy in amenorrhoea, given in 
the dose of 2 to 8 minims (0.1-0.5) three times a day for a week 
before the proper date for menstruation. It should be given, if pos- 
sible, in capsules, owing to its bad taste. It is said not to possess 
any abortive influences, although it is often taken with this object in 
view. 

Apiol is imported from France in capsules containing a little less 
than 3 minims (0.15). 

APOMORPHINE. 

Apomorphine is an artificial alkaloid obtained by the action of 
hydrochloric acid upon morphine in a sealed tube to which is applied 
a high heat. It is a whitish or gray powder, made up of minute 
crystals, which rapidly undergo decomposition when exposed to the 
air. The drug should be kept in dark bottles well stoppered. A 
very important point to remember is that solutions rapidly decom- 
pose, and, if employed, may produce poisonous symptoms. The drug 
ought to be freshly dissolved each time it is used. If the salt imparts 
an emerald-green color to 100 parts of water when shaken a few times, 
it should be rejected, unless it is found that the water contains small 
amounts of ammonia, which is supposed to be active in causing such 
a change. 

Physiological Action. — One of the best studies of this drug is that 
of Reichert, who found that in poisonous doses it produces convul- 
sions, and finally paralysis which is chiefly spinal in origin. 

Nervous System. — On the nervous centres in the brain apomor- 
phine acts as a stimulant, but the convulsions produced by poisonous 
doses are probably spinal. The motor and sensory nerves are finally 
paralyzed, and even the muscles become poisoned and incapable of 
contraction. 

Circulation. — Apomorphine increases the rapidity and force of 



76 DRUGS. 

the pulse and raises arterial pressure, when given in moderate 
amounts, by stimulation of the accelerator nerves and the vasomotor 
centre. In large doses it acts as a circulatory depressant. 

Respiration. — After ordinary amounts no changes in respiration 
occur, but after poisonous doses the breathing becomes rapid and 
irregular. 

Vomiting. — Vomiting is produced by a direct action of the drug 
upon the vomiting centre in the medulla, and not by an action on the 
stomach. Apomorphine is, therefore, a typical centric emetic. 

Therapeutics. — Apomorphine is useful in nearly all cases where an 
emetic may be employed. In poisoning from other drugs, particu- 
larly depressants and narcotics, we have little knowledge of its safety, 
but, unless the stupor or circulatory change is very profound, the 
drug may be used with care. In subacute and chronic catarrh of the 
stomach and air-passages it may be useful in getting rid of the mucus 
by emesis, and it is a useful remedy in acute bronchitis when it is 
necessary to quiet irritation or when the secretion which has been 
poured out is very scanty. 

Administration. — The drug when used as an emetic should always 
be given hypodermically and the solution be freshly prepared. The 
emetic dose is about y 1 ^ of a grain (0.006), but as much as -j- (0.01) 
may be used in strong patients. The expectorant dose is -^ to ^V 
of a grain (0.0015-0.003) by the mouth. No nausea is usually felt. 
The drug nearly always acts badly by children, and it is better not 
to use it in this class of patients. The salt used is Apomorphinoe 
Hydroehloras, U. S. and B. P. An injection (Injectio Apomorphinoe 
Hypodermica) — 2 grains (0.1) dissolved in 100 minims (6.5) of cam- 
phor-water — is official in the B. P. 



ARISTOL. 

(See Thymol Iodide.) 

ARNICA. 

Arnica is a medicine derived from Arnica montana, a native plant 
of the Western United States and Europe. It holds a very high 
position in domestic medicine as a local and internal remedy in sprains 
and bruises and in the treatment of passive hemorrhages, amenor- 
rhea, and similar states. Two parts of the plant are official — the 
arnica-flowers (Arnicce F lores, U. S.) and the root (Arnica? Radix, 
U. S., Arnicce Bhizoma, B. P.). 

Physiological Action. — When arnica is applied to a delicate skin, 
it produces burning and irritation, and even extensive skin lesions. 
According to the studies of the author, it slows the pulse, raises the 
blood-pressure slightly, and stimulates the vagus nerves. Toxic doses 
produce a rapid pulse from paralysis of these nerves. 

Administration. — Arnica is rarely given internally. If it is so 



ARSENIC. 77 

used, the dose of the tincture (Tinctura Arnicoe Radicis, U. S.) is 
15 to 30 drops (1.0-2.0), and the same amount of the tincture of the 
flowers (Tinctura Arnicoe Florum, U. S.) may be employed. The 
solid (Extr actum Ar niece Radicis, U. S.) and the fluid extract of the 
root (Extractum Arnicoe Radicis Fluidum) are also official. The dose 
of these preparations is 3 to 5 grains (0.15-0.3) and 5 to 10 minims 
(0.3-0.65) respectively. The plaster (Emplastrum Arnicoe, U. S.) is 
very useful for external applications. 

The tincture is the preparation usually applied to sprains and 
bruises, and the alcohol contained therein accomplishes a large part 
of the good achieved. 

The only British preparation is the tincture (Tinctura Arnicoe), 
which is given in the dose of 30 minims to 1 drachm (2.0-4.0). 

ARSENIC. 

Arsenic (Arsenicum) itself is never employed in medicine, but it 
is used in the form of arsenous acid or the arsenates of sodium, 
potassium, or copper. 

Arsenous acid (Acidum Arsenosum, XI. S. ; Acidum Arseniosum, 
B. P.) is derived from arsenic-bearing ores by roasting them in a 
reverberatory furnace, when it rises in the form of a vapor which 
adheres to the walls of the furnace, requiring a second sublimation, 
owing to the first deposit being quite impure. It is soluble in water, 
is without odor, and when heated gives off the smell of garlic. 

Physiological Action. — The changes produced in man by poisonous 
doses will be found considered under the heading of Poisoning, and 
the writer will now confine himself to a study of the effects of medici- 
nal amounts. 

Applied to the normal skin, arsenous acid produces no change of 
any moment whatever, but if the surface be broken or a wound or 
sore exist, its action is very powerful, and it destroys the tissues to a 
considerable extent. For this reason it has been employed as a caustic 
by "quacks" and to some extent by regular physicians, the latter 
using it to remove warts, condylomata, and similar growths, while the 
former have employed it chiefly as a " cancer cure," asserting that it 
would take the disease " out by the roots." 

Nervous System. — When small amounts of arsenic are given to 
animals, particularly those of the lower types as represented by the 
frog, reflex action is lost long before, or more rarely at the same time, 
that voluntary movement is put aside, and, finally, all sensation to 
pain produced by heat and pinching totally ceases. It is therefore 
quite evident that the sensory nervous apparatus is affected, and 
experiments have proved that the sensory tract of the spinal cord is 
at fault. Ultimately, however, the motor system also fails and com- 
plete motor palsy ensues. Arsenic in poisonous amount acts as a 
depressant poison to all protoplasm with which it may come in con- 
tact (Ringer and Murrell). In medicinal amounts the drugs acts 
as a nervous excitant and as a stimulant to the trophic nervous 
apparatus. 



78 DRUGS. 

Circulation. — In moderate amounts arsenic has little or no in- 
fluence upon the circulation. Large doses cause marked decrease in 
the force and frequency of the pulse, accompanied by a decided fall in 
arterial pressure, and in these amounts it is to be regarded as a distinct 
cardiac depressant which depresses all the heart's component parts, 
such as the ganglia, muscle, and nerves. The fall of the arterial pres- 
sure is due to vasomotor depression with relaxation of the general 
blood-vessels, more especially those of the abdominal cavity. Accord- 
ing to Lesser, small doses cause it to act as a cardiac stimulant, 
increasing the pulse-rate. Arsenic is absorbed by the blood-vessels. 

Respiration. — In small amounts arsenic very distinctly stimulates 
the respiratory centre, and Lesser asserts that small doses stimulate 
the peripheral ends of the vagi in the lungs, but that in toxic quan- 
tities arsenic acts as a powerful respiratory depressant. 

Elimination. — Arsenic escapes from the body chiefly by the kid- 
neys and bowels. In poisoning the purging which is produced carries 
off much of the drug, but after medicinal amounts some traces of it 
may be found in the saliva and in the milk of nursing women. The 
writer has seen colic produced in infants taking milk at the breasts 
of women who were receiving large doses of Fowler's solution. 

Tissue-waste. — According to Chittenden and Cummins, arsenic 
in medicinal amount distinctly decreases tissue-changes. Large doses, 
however, greatly increase nitrogenous metamorphosis. 

Therapeutics. — Arsenic is used in chorea, in which it is almost a 
specific, acting in an unknown manner. Small doses should be given 
at first, and later on the dose should be increased rapidly, as patients 
soon get accustomed to the drug. Cases are on record, however, in 
which the too rapid increase of the drug in medicinal doses has 
developed arsenical neuritis. As a tonic combined with iron it is 
invaluable in malarial ancemia and cachexia. In atony of the mucous 
membrane of the stomach and intestines it is exceedingly useful, and 
in ordinary anaemia and debility, combined with a simple bitter tonic, 
it is invaluable. Arsenic offers the best chance of saving cases of per- 
nicious anozmia. In leueoeythcemia and pseudo-leukwmia arsenic is 
again the remedy, and it must be constantly given to the point of 
intolerance to be of value. In the latter disease good results have fol- 
lowed its use when intraglandular and intrasplenic injections of 4 drops 
(0.2) of Fowler's solution were used. In malaria it acts as a prophy- 
lactic, as a cure, and as an aid to convalescence. When the attacks 
of intermittent fever are far apart, arsenic is useful as an antiperiodic, 
quinine being withheld for use during the attack itself. Arsenic is 
of value, too, for the improvement of depraved mucous membranes of 
the respiratory tract, particularly in those persons who have not true 
tuberculosis, but phthisical tendencies ; that is, individuals who con- 
tinually have colds in the head, chest, or elsewhere. 

No drug is so universally abused as is arsenic in the treatment of 
skin disease : it should never be employed in " wet " skin diseases ; 
that is, those associated with much proliferation of new cells and the 
exudation of serum and other liquids. Its field of usefulness is in 
the dry, scaly shin affections. 



ARSENIC. 79 

Where the skin is affected in its lower layers arsenic is useless, and 
should be used only where the epiderni is diseased (Duhring). 

In psoriasis arsenic at first makes the skin more red and seemingly 
worse, but this passes off and the disease gets well. This is important 
to remember, as otherwise the drug may be stopped just at the wrong 
time. Pemphigus, lichen, and lepra all yield to its influence in most 
instances. 

In the treatment of diabetes and pruritus vulva? the drug is said to 
be of value when given internally. In gouty diabetes the use of the 
carbonate of lithium and the arsenate of sodium is often of great 
service. 

In asthma, particularly where the mucous membranes are at fault, 
arsenic is one of the best remedies that we have, either given internally 
or smoked in arsenic cigarettes, which are to be made as follows i 1 

R. — Belladonna? foliorum gr. xcvj. 

Hyoscyam. foliorum gr. xlv. 

Straraonii foliorum gr. xlv. 

Extract, opii gr. iv. 

Tabaci gr. lxxx. 

Aquse Oj. — M. 

Ft. sol. et adde. 

Potassii nitratis gr. clx. 

Potassii arsenitis gr. cccxx. — M. 

Bibulous paper is to be wetted with this compound, and after drying is to be rolled up 
and smoked as a cigarette. 

A more simple procedure is to wet bibulous paper in a solution of 
arsenite of potassium of the strength of 15 grains to the ounce. 

In chronic rheumatism arsenic is very valuable in certain cases, but 
often fails to be of service. In coryza, in cancrum oris, severe sore 
throat, and chronic nasal catarrh it is to be employed internally, and 
in some cases of hay fever undoubtedly affords relief. The use of 
arsenic in all stages of phthisis often gives the most surprising results. 
In gastric cancer and ulcer, given in small amounts frequently repeated, 
arsenic will often do good by relieving the pain and checking the 
vomiting. It may be tried in the vomiting of pregnancy with some 
chance of success. In atonic dyspepsia associated with chronic diar- 
rhoea and with evidences of dysentery arsenic is of service, and in 
small amounts it is very valuable in frequently repeated doses (y^o" 
of a grain (0.0006) every hour) in all forms of serous diarrhoea. 

For gastric atony or torpidity the following prescription is useful, 
but if irritation of the stomach is present it should not be employed : 

R.— Liq. potassii arsenitis - . • • f^ss (2.0). 

Tr. micis vomicae f.^.j (4.0). 

Aquse q. s. ad f^iij (96.0).— M. 

S. — Teaspoonful (4.0) t. d. in water after meals. 

In old persons whose feet become swollen and hot after prolonged 
standing, and who have shortness of breath on exertion, arsenic does 
good. 

Locally applied to ivarts and other growths of the skin for several 
days in the form of Liquor Arsenicalis (B. P.) or Liquor Acidi Ar- 
1 Philadelphia Hospital Pharmacopoeia. 



80 DRUGS. 

senosi (JJ. S.), or of Fowler's solution, it causes the growth to drop off 
or to become very much loosened. Where the growth is very hard 
and horny, its surface should be softened by the application of liquor 
potassa before the arsenical liquor is applied. The same treatment may 
be used for corns, and salicylic acid is employed in a similar manner, 
but is not so efficient. Where large growths with wide surfaces are to 
be attacked the physician must use arsenic most boldly or not at all. 
The danger of absorption is only escaped when the drug is used so 
generously as to destroy the tissues before they can carry on any 
absorption of the poison. Marsden recommended the use of 1 ounce 
each of arsenious acid and powdered gum acacia to 5 drachms of water 
as an application to epitheliomatous growths. 

Administration. — Children generally bear more arsenic than adults, 
proportionately, and Ringer states that boys bear less than girls. The 
drug should generally be administered after meals, as it is apt to irritate 
the stomach if given when this viscus is empty. Whenever a patient 
is given arsenic, he should be cautioned to watch for any puffiness 
about the eyes, particularly in the morning on arising, and for slight 
laxity of the bowels and griping. These are signs that the drug 
should be stopped for a day or more. The swelling under the eyes 
may spread if the use of the drug is persisted in, and finally amount 
to general anasarca. This is due at first to a cellulitis, and afterward 
to a true effusion. 

The official preparations are : arsenous acid (Acidum Arsenosum, 
JJ. S., Acidum Arseniosum, B. P.), the dose of which is fa to fa 
of a grain (0.0015-0.003); the solution of the arsenite of potassium 
(Liquor Potassii Arsenitis, JJ. S. ; Liquor Arsenicalis, B. P.) or Fow- 
ler's solution, the dose of which at first is from 1 to 5 drops (0.05-0.3) 
in water; the solution of arsenate of sodium (Liquor Sodii Arsenatis, 
JJ. S. and B. P.), or Pearson's solution, the dose of which is 1 to 5 
drops (0.05-0.3), and the solution of arsenous acid (Liquor Acidi 
Arsenosi, JJ. S. ; Liquor Arsenici Hydrochloricus, B. P.), the dose of 
which is 1 to 5 drops (0.05-0.3). This is more irritating to the stom- 
ach than the other preparations. The iodide of arsenic enters into 
Donovan's solution (Liquor Arseni et Hydrargyri Iodidi, JJ. S. and 
B. P.), the dose of which is 1 to 3 drops (0.05-0.15) well diluted. 
Iodide of arsenic (Arseni lodidum, JJ. S. and B. P.) is given in fa- 
grain (0.0015) doses, and arsenate of sodium (Sodii Arsenas, JJ. S. 
and B. P.) in the dose of -fa to fa of a grain (0.003-0.006). 

Acute Poisoning. — Arsenic is a gastro-intestinal irritant, producing, 
when taken in poisonous dose, violent vomiting and purging, with 
great pain in the oesophagus, stomach, and entire belly. The passages 
are finally watery and resemble "rice-water" stools, but are to be 
separated from those of cholera and antimonial poisoning by the pres- 
ence of blood, and, if necessary, by chemical analysis. The mucous 
membrane is stripped off the bowel and in the passages appears in 
shreds. Very commonly about the third day, if the patient survive so 
long, an intermission in the attack appears, which will only be followed 
by a return of all the symptoms, so that the physician must not give a 
favorable prognosis. In this symptom (remission) arsenical poisoning 



ARSENIC. 81 

resembles phosphorus poisoning and yellow fever. Death generally 
occurs about the fourth or sixth day, and on or about the third day a 
peculiar skin eruption appears which may be of any character. In 
rare cases sudden pain, collapse, and death may take place after the 
ingestion of the poison. Widespread multiple neuritis may be brought 
on. A typical change always present in acute poisoning when the pa- 
tient lives for any length of time is fatty degeneration of all the tissues. 

Treatment of Acute Poisoning. — Besides washing out the 
stomach by the stomach-pump, applying external heat and stimulants, 
the proper antidotes should be at once employed, and the only ones of 
any value are the freshly-precipitated hydrated sesquioxide of iron and 
magnesia. (Bee below.) The first is to be prepared by the precipita- 
tion of iron from one of its fluid preparations by the use of an alkali. 
Ammonia added to the tincture of the chloride of iron is efficacious, 
but the precipitate has to be repeatedly washed to rid it of an excess 
of this irritant. Magnesia is a better precipitant, because it not only 
precipitates the iron, but is an antidote itself. Monsel's solution and 
the so-called dialyzed iron may be employed in place of the tincture, 
but the Monsel's salt is too irritating, and the dialyzed iron is so 
readily precipitated that it needs no alkali, but may be given pure. 
Magnesia is a useful antidote when used alone. 

Under the name Ferri Oxidum Hydratum cum Magnesia the U. S. 
P. recognizes an antidote for arsenic ; this is often called the " anti- 
dotum arsenici." The U. S. P. directs that this antidote should be 
kept on hand for immediate use in the following manner : Mix 13^ 
fluidrachms (50.0) of the official solution of the tersulphate of iron 
(Liquor Ferri Tersulphatis) with 4|- ounces (100.0) of water and keep 
the mixture in a well-stoppered bottle. Rub 150 grains (10.0) of 
magnesia with a little water to a smooth and thin mixture; transfer 
it to a bottle capable of holding 32 ounces (1000,0), and fill the bottle 
with water. When the antidote is to be used, add the magnesia solu- 
tion slowly to the iron solution and shake together until a homoge- 
neous mass results. 

After the use of the antidote emetics should be used, opium should 
be used to allay irritation and pain, and large draughts of water be 
given to flush the kidneys and dilute the poison. In the later stages 
the danger from arsenical poisoning arises from the changes produced 
in vital organs. 

Chronic Poisoning by arsenic shows itself in great irritation of the 
air-passages, in diseases of the kidneys, in pigmentation of the skin, 
and in nervous symptoms due to inflammations of the nervous tissues 
in different parts of the system, such as patches of anaesthesia and 
localized loss of motor power. These anaesthetic areas are generally 
confined to the extremities, and extend only to the first or the second 
joint above. Sometimes the multiple neuritis produced by arsenic 
produces symptoms which resemble those of locomotor ataxia to 
a very considerable extent. In other cases the action on the skin 
is the more marked, and various acute inflammatory conditions are 
produced. Arsenic often produces asthma in those exposed to it by 
reason of the irritation it causes in the bronchial tubes. Chronic 



82 DRUGS. 

poisoning is to be treated by withdrawal from the exposure and the 
use of iodide of potassium to aid in the elimination of the arsenic. 
The other symptoms are to be treated by the application of electricity, 
tonics, out-of-door life, and such measures as will improve the general 
condition of the patient. 

ASAFCETIDA. 

Asafoetida, U. S. and B. P., is a gum obtained by making an 
incision into the root of the Ferula Narthex. It occurs in irregular 
masses of a dark-yellow or reddish color, which become still more 
red if exposed to the light and air. Asafoetida in tears is a term 
applied to the drug when it appears in the shape of drops or pearls, 
and is a form seldom seen. Its odor is penetrating and strong, and 
resembles that of garlic. When taken internally it causes a sensa- 
tion of warmth and acts as a stimulant and carminative in the ali- 
mentary canal. 

Therapeutics. — Asafoetida is used in medicine as a carminative 
which will particularly affect the lower bowel, and is useful in the 
intestinal indigestion of old persons when associated with flatulence, 
and in the flatulent colic of children. By way of rectal injections it 
is of value in the tympanites of children and in that of adults during 
typhoid fever. It is also used as a stimulating expectorant in the 
later stages of bronchitis. In the nervous irritability of children it is 
often of service. 

Administration. — Asafoetida is given in pills of asafoetida (Pilule 
Asafoetida?, U. S.), of which two or three may be taken, each one 
containing 3 grains (0.15); the emulsion or milk of asafoetida (Emid- 
sum Asafoetida 3 , U. S.), the dose of which is -^ to 1 ounce (16.0-32.0) ; 
and the tincture (Tinctura Asafoetida;, U. S. and B. P), \ to 1 fluid- 
drachm (2.0-4.0). The suppositories contain what is equal to 40 
drops (3.0) of the tincture; and the plaster of asafoetida {Emplastrum 
Asafoetida;) is used where a faint counter-irritant and antispasmodic 
is needed. When intestinal indigestion and flatulence occurs in old 
people the following pill is of service : 

R. — Extracti nucis vomicae gr. vJO.30). 

Extracti physostigmatis gr. iij (0.15). 

Asafoetidse gr. xl (2.6).— M. 

Ft. in pil. No. xx. 
S. — One night and morning. 

The B. P. preparations not official in the U. S. P. are Enema 
Asafoetida? and Pilula Asafoetidoe Composita, composed of asafoetida, 
galbanum, and myrrh ; dose 5 to 15 grains (0.35-1.0). 

ASPIDIUM. 
Aspidium, U. S., Filix Mas, B. P., or Male Fern, is employed in 
medicine as a tseniacide or remedy against the tape-worm, and is a 
very efficient and valuable drug under such circumstances, being, per- 
haps, the most reliable of all the vermifuges except pelletierin. When 



BARIUM CHLORIDE. 83 

employed the directions and precautions given in the article on Worms 
must be strictly followed. 

Administration. — Male fern is rarely, if ever, used at present in 
its crude form, being employed most commonly in this country in the 
form of the oleoresin (Oleoresina Aspidii, U. S.) ; dose \ to 1 fluid- 
drachm in capsules, or as follows : 

R. — Oleoresin. aspidii ) _- w ■. / OA \ 

tw ™nin£ r aa ^xiv (3.0). 



Tinct. vanillas 

Pulv. acacias ^ss (2.0). 

Aq. destillat. . > f&j (32.0).— M. 

S. — Take entire amount after fasting, and follow in two hours by a full dose of castor 
oil or sulphate of magnesium. 

The dose of the liquid extract (Extr actum Filicis Liquidum) of 
the B. P. is 15 minims to 1 fluidrachm (1.0-4.0). 

Katamaya and Okamoto, two Japanese investigators, both state 
that castor and other oils should not be used after filix mas is given, 
as oils increase its absorbability, and so predispose to the develop- 
ment of poisoning. 

AZEDARACH. 

Azedarach is the bark of the Melia Azedarach, or Pride of China, 
as it is sometimes called. It is found in Syria, Persia, the north of 
India, and in the Southern United States. 

The drug has but little toxic power, and children may eat of it 
largely without ill effect. If very large amounts are used, gastro- 
intestinal inflammation occurs. It is employed as a remedy against 
the round-worm, and should be given in decoction made by boiling 2 
ounces of the drug in 1^ pints (750 cc.) of water until there only 
remains a pint (500) of liquid. Of this from 1 to 2 tablespoonfuls 
(16.0-32.0) are to be given a child, and repeated every two hours 
until the bowels are opened. It has also been used as a fluid extract 
prepared by the ordinary means with alcohol, to which some white 
sugar should be added. The dose of this extract is a teaspoonful, and 
is not to be repeated. The decoction is the best form in which to use 
the drug. 

BARIUM CHLORIDE. 

One of the most recent and one of the best evidences of the value 
of the study of the action of drugs upon the lower animals is given 
us by this substance. It will be remembered that Brunton and Ringer 
of London, Robert and Bary of Dorpat, and Bartholow and the 
writer in America have at various times published, during the last 
few years, studies concerning the effect of barium on the circulatory 
apparatus of the frog, dog, and man, and all of them are in accord 
in the statement that it slows the heart very greatly, steadies its 
rhythm, and at the same time increases the volume of blood thrown 
out of the ventricle. They have also found that barium increases 
blood-pressure, and Robert has, by a series of careful experiments, 



84 DRUGS. 

concluded that it brings about this change by an action on the mus- 
cular coats of the blood-vessels. 

If large doses are used in the lower animals, the heart suffers sys- 
tolic arrest from over-stimulation, and the strongest irritation of the 
vagus nerves fails to relax the systolic contraction. Still more inter- 
esting is the statement that this failure of the vagi to inhibit the 
heart is not the result of paralysis of these nerves, but is simply due 
to the excess of cardiac contractile power. The slowing of the pulse 
is not due to inhibitory influence, but depends solely upon the stimu- 
lation of the heart-muscle, although it would seem probable that the 
vasomotor stimulation, by increasing the arterial resistance, may be 
at least a factor in the reduction of the pulse-rate. At one time, in 
the dog, after large doses, there is a period of increase of pulse-rate 
which is asserted to be due to stimulation of the accelerator nerves. 

In most works on chemistry barium is stated to be an irritant 
poison, but to produce such evidences of its presence the dose given 
must be extremely large, and many times greater than any amount 
useful for medicinal purposes. 

Therapeutics. — Barium chloride may be used in all forms of car- 
diac disease in which failure of the heart-muscle is present. In the 
treatment of varicose veins it is said to be of value, both when given 
internally and applied locally over the distended vessels. 

A point worthy of remark is the character of the pulse-wave pro- 
duced. While its volume is increased, it does not give that sensation 
of tenseness to the finger that does digitalis, and the pulse-w T ave seems 
to be very considerably prolonged — a fact that the sphygmograph 
also records. 

Administration. — The solution of barium chloride to be used inter- 
nally should have the strength of 5 grains to the ounce (0.3 : 32.0) 
of water, and of this 1 or 2 teaspoonfuls (4.0-8.0) is to be given three 
times a day. 

BELLADONNA. 

Belladonna is botanically known as Atropa Belladonna, and is 
official in the form of the root (Belladonna? Radix, U. S. and B. P.) 
and leaves (Belladonna? Folia, U. S. and B. P.). It belongs to a 
very large class of plants which all have a similar physiological action. 
Belladonna contains an active principle in the form of an alkaloid 
known as atropine (Atropina, U. S. and B. P.), which is insoluble in 
water. The sulphate of atropine (Atropina? Sulphas, U. S. and B. 
P.) is soluble. 

Physiological Effects. — In man, full medicinal doses produce flush- 
ing of the face, redness and dryness of the fauces, dilated pupils, 
sometimes an erythematous rash over the skin, rarely diplopia and 
delirium. If the dose be still larger, the delirium becomes very 
marked and is wild and talkative. The pulse is rapid and wiry. The 
rash which appears resembles that of scarlet fever, but lacks the punc- 
tations. The skin may desquamate after several days if the rash is 
severe. 



BELLADONNA. 85 

In children, belladonna is usually borne very well indeed, and 
opium very badly. When belladonna asserts itself in children, the 
respiration is quickened, the eyes become bright and the cheeks red, 
but lines of pallor reach from the malar bones to the corners of the 
mouth, giving the face a curious expression. 

Nervous System. — Belladonna when given in medicinal amount 
approaching the toxic dose acts as a powerful excitant of the brain, 
producing talkative delirium. 

When very large doses are given, paralysis of the spinal cord 
comes on, which is followed by tetanic spasms, and finally by recov- 
ery. The primary loss of power is due to paralysis of the entire cord, 
and the second state, of convulsions, to the escape of the motor and 
sensory pathways from the paralysis before the inhibitory centres 
recover. As a result, any peripheral irritation causes violent explo- 
sions of motor power. 1 Even in large medicinal dose belladonna may 
be considered as a depressant to the motor nerves and as a quieter to 
sensory nerve-filaments. On voluntary muscles the drug has no effect, 
but upon unstriped muscles it acts as a depressant and antispasmodic. 
It distinctly lessens reflex action. 

Circulation. — Belladonna quickens the pulse by depression of 
the peripheral vagi and by stimulating the cardiac muscle. It pro- 
duces a rise of arterial pressure by stimulating the vasomotor centre 
and by the increased heart-action which it causes. In poisonous 
doses it causes a fall of arterial pressure due to centric vasomotor 
palsy, and depression of the muscular coats of the blood-vessels, but 
not to cardiac depression, as has been generally taught, for Reichert 
has proved that the drug is not a heart-depressant unless the dose is 
simply overwhelming. Sometimes when belladonna is given the pulse 
becomes slow, but in these cases the slowing is due to temporary stim- 
ulation of the peripheral vagi or to momentary depression of the car- 
diac motor ganglia. 

Respiration. — Atropine is a stimulant to the respiratory centre 
in ordinary amounts, but recent careful studies show that its high 
reputation as a respiratory stimulant is not based either on clinical 
or experimental experience. In many cases it fails to increase the 
respiration at all, and it is certainly inferior to coffee and strychnine 
in the treatment of opium poisoning. In large doses it is a depressant 
and paralyzant to respiration, and produces death from respiratory 
failure due to paralysis of the motor nerves supplying the respiratory 
muscles, and probably by depressing the respiratory centres. 

Abdominal Contents. — Belladonna increases peristalsis by de- 
pressing the peripheral ends of the inhibitory fibres of the splanchnic 
nerves, and by diminishing any tendency to spasm on the part of the 
muscular coats of the intestine. 

Action on Secretion. — The drug decreases all the secretions of 
the body except the urine, which is sometimes increased in amount 

1 If a homely simile, found useful by the writer in teaching, may be used, the 
inhibitory centres may be represented by a schoolmaster and the motor and sensory 
centres by two boys. The escape of chloroform in the room paralyzes them all, but, 
finally, the boys recover before their master and go off as truants (convulsions) ; at 
last the master (inhibitory centres) recovers, and order, or health, is restored. 



86 DRUGS. 

under its use. The decrease of secretion is due to paralysis of the 
peripheral nerve-filaments supplying the secretory cells of the 
glands. 

Bodily Heat. — When belladonna is used in large amounts there 
is nearly always a rise of temperature, which in children may amount 
to one or two degrees. In advanced poisoning the temperature rap- 
idly falls. 

Elimination. — Atropine is eliminated by the kidneys and bowels, 
and is partly destroyed in the liver. In a suspected case of poisoning 
the urine of the patient may be dropped in the eye of an animal, and, 
if atropine or belladonna has been taken, mydriasis will result. 

Eye. — On the eye belladonna produces dilatation of the pupil by 
stimulating peripherally the sympathetic nerve-fibres of the iris and 
paralyzing the ocular motor fibres, but the dominant action of the 
drug is undoubtedly exercised upon the muscular fibres of the iris 
(Jessup). Littauer has recently asserted that dilatation is not due to 
sympathetic stimulation, but Jessup's conclusions are generally accepted 
as correct, although the teaching as to the influence of atropine on the 
eye has changed several times in the last few years. Belladonna gen- 
erally increases intra-ocular tension. 

Treatment of Poisoning. — Poisoning by belladonna is to be 
treated by the application of external heat if the patient goes into 
collapse, and the use of strychnine if respiration fails. Opium may 
be employed in carefully graded doses as the physiological antagonist, 
but large doses are of doubtful service, particularly if the respirations 
are not in a satisfactory state. 

Therapeutics. — Belladonna is used to allay excessive secretion, to act 
as an antispasmodic, and to influence the circulatory apparatus when 
local inflammations are beginning, particularly in secretory glands. 
In cardiac palpitation small doses of belladonna internally, or its 
external use over the prsecordium in the form of a belladonna plaster 
or ointment, is very useful. It is also our most useful vasomotor stim- 
ulant in shock. Belladonna is of value in neuralgias and in the pains 
due to irritated peripheral nerves. 

To check secretion in night-sweats it is one of the best remedies we 
have, and it is useful in excessive idiopathic ptyalism, as seen in chil- 
dren, or in that due to mercurialization. In bromidrosis of the feet 
and other localized sweatings it is useful, and may be employed locally 
or taken internally for their cure. It is the best drug we have for 
checking the secretion of milk in an inflamed breast, and under these 
circumstances it is best to smear it over the gland in an ointment. 
Belladonna may be used in serous diarrhoea, as it checks the disorder 
by stimulation of the splanchnic vasomotor filaments of the intestinal 
blood-vessels, which being inactive permit a transudation of liquid 
into the bowel. 

Trousseau recommended as a local remedy 1 to 2 grains (0.05- 
0.10) of the extract of belladonna with 6 to 8 grains (0.30-0.40) of 
tannic acid in leucorrhoea dependent upon disease of the uterine cer- 
vix. This should be placed on a pledget of cotton and applied to 
the affected part daily, being allowed to remain all day. Ringer 



BELLADONNA. 87 

states that if pain is also present in these cases the following injec- 
tion is of value : 

R. — Sodii bicarbonatis 3j (4.0). 

Tr. belladonna f^ij (8.0). 

Aquae dest q. s. ad Oj (500 cc). — M. 

This is to be injected into the vagina, the woman first being placed on 
her back with her buttocks raised, so that the drug may bathe the 
uterine cervix for some minutes. 

As an antispasmodic, atropine is to be used in torticollis, injected 
directly into the muscle itself, so as to act on its motor nerve-fibres, 
and it may be given in spasm of the intestine with cramps and griping, 
while in cramps in the legs and body, either as a local application by 
means of liniments or when employed internally, it is of service. 
In asthma of the spasmodic type belladonna is a sovereign remedy, 
particularly if it be combined with morphine. It may be used both 
as a prophylactic and as a cure during the attack. The belladonna- 
leaves may be smoked by rolling them into a cigarette or putting 
them into a pipe. 

This drug is used in whooping cough at all ages and in all stages, 
but it has generally to be given in large amounts in this disease to do 
any good. 

In spasm of the sphincter ani, that which is either idiopathic or 
due to fissure, belladonna in the form of an ointment or suppository 
is of value. In spasm of the urethra and bladder the drug may be 
used internally and externally, and in the former state the ointment 
should be smeared along the under surface of the penis every night. 
This treatment is also useful in chordee. In the colic resulting from 
the passage of hepatic and renal calculi belladonna in full dose will 
nearly always give relief. Where urinary incontinence depends upon 
spasm of the bladder belladonna should be used. (See Urinary Incon- 
tinence.) In dysmenorrhoea in nervous women, with spasm of the 
cervix uteri, it is of very great value applied as an ointment or in a 
vaginal suppository, or when given by the mouth. For the nervous 
cough of children and adults belladonna is one of the best remedies 
we have. In constipation it does good by depressing the inhibitory 
nerves of the intestine. It is also of value in laryngismus stridulus 
and in hiccough. In spasms from peripheral irritations belladonna is 
of value. In iritis atropine is used to dilate the pupil and prevent 
adhesions. The solution to be dropped into the eye should contain 1 
to 4 grains (0.05-0.20) of atropine sulphate to the ounce (32.0) of 
water. Atropine sulphate is also used for the purpose of producing 
mydriasis, before ophthalmoscopic examination, in solutions of the 
strength just given. It increases intra-ocular tension and is contra- 
indicated in glaucoma. When employed to act on the circulation it 
is to be used in shock and collapse from injury or in the course of 
severe disease. (See Shock.) During the progress of a case of 
pneumonia, typhoid fever, or other severe disease belladonna should 
be kept in the house, and administered freely if collapse or vasomotor 
relaxation suddenly asserts itself. Particularly is this true in the 



88 DRUGS. 

case of pneumonia. The vascular system after crisis will often be found 
much relaxed, and stimulants do not seem to do much good. The 
administration of atropine or belladonna will dry the leaking skin, and 
by increasing the vasomotor tone produce great improvement. In mas- 
titis, or inflammation of the breast, even where pus is beginning to be 
formed, belladonna, if pushed, will give surprisingly good results if 
given internally and applied locally. In sore throat, when the phar- 
ynx is hot and dry and has a sensation of rawness, Avhile the local 
capillaries appear injected and red, belladonna is often of the greatest 
service if given in full dose, aborting the "cold." In exop)hthalmic 
goitre belladonna is thought to act by stimulating the sympathetic 
nerves, and certainly gives relief in some cases, particularly if com- 
bined with strophanthus or digitalis. For the relief of local nerve- 
pains it is of value, and probably acts by quieting the irritated nerve. 
It should be applied in these cases in the form of an ointment or 
plaster, and be well rubbed into the part affected. 

In headache occurring in young persons, often due to over-work, 
with pain in the eyeballs and forehead and a sensation as if the orbits 
were too small for the eyeballs, belladonna is of service. In intercostal 
neuralgia or pleurodynia belladonna plasters may be applied to the 
spot where the pain is felt, with relief. 

Use of Atropine in Poisoning. — Atropine acts as an andidote in 
cases where poisonous mushrooms have been eaten, and is a physio- 
logical antidote to opium, Calabar bean or physostigma, and jaborandi. 
In opium poisoning it acts as an antidote in all parts of the body 
except the eye, and in jaborandi poisoning the same facts hold true. 
In opium poisoning the drug should not be given after the respira- 
tions rise to ten from three or four per minute, as too much of the 
drug may be given and atropine poisoning may come on and compli- 
cate the case. The condition of the pupil is not a guide as to the 
effect of atropine in opium poisoning, because opium acts centrically 
and atropine acts peripherally on the nerves governing the iris. 
Atropine should be used in aconite, antimony, and hydrocyanic-acid 
poisoning for its influence on the vasomotor system, the respiratory 
centre, and the heart, and for the purpose of maintaining the bodily 
heat, the dissipation of which it retards by preventing vasomotor 
palsy and consequent dilatation of the peripheral blood-vessels. It 
should be borne in mind that atropine is not the very best single 
antagonist to opium, and that in opium poisoning it always should be 
largely aided by caffeine and strychnine. 

Administration. — The dose of the sulphate of atropine {Atrophia 3 
Sulphas, U. S. and B. P.), is ^h to To (0.0004-0.0015) of a grain. 
The alcoholic extract (Extractum Belladonnas Foliorum Alcoholicum, 
U. S. and B. P.) is given in -J to ^ grain (0.01-0.015) doses, and the 
tincture (Tinctura Belladonnai Foliorum, U. S. and B. P.) in the dose 
of 5 to 15 minims (0.3-1.0). Both these preparations are derived 
from the leaves. The fluid extract {Extractum Belladonnoe Radicis 
FJuidum, U. S.) is given in 1- to 2-minim (0.05-0.10) doses, while 
the extract of the B. P. is given in \- to 1-minim (0.015-0.05) doses. 
These preparations are derived from the root. Succus Belladonnoe, 



BENZOIN AND BENZOIC ACID. 89 

B. P., is given in 5- to 15-minim (0.3-1.0) doses. The preparations 
of the B. P. not official in the U. S. P. are Liquor Atropinoe Sulphatis, 
given in the close of 1 to 6 minims (0.05-0.32); Lamellce Atropinoe, 
each of which contains ^qq of a grain of atropine ; and TJnguentum 
Atropinoe. Belladonna liniment (Linimentum Belladonnce, TJ. S. and 
B. P.), belladonna plaster {Emplastrum Belladonnce, TJ. S. and B. 
P.). and the ointment {TJnguentum Belladonna, U. S. and B. P.) 
are for external application. 

Recent experiments show that belladonna decreases gastric secre- 
tion very considerably in some persons. It is better, therefore, not 
administer it just before or immediately after a meal. 



BBNZOATE OF BISMUTH. 

This is a preparation which has been highly recommended in Ger- 
many, and to some extent in this country, within the last few years, 
in the treatment of chancroid. Under its influence the sore heals up 
with great rapidity and leaves a comparatively small cicatrix. It may 
also be used in the treatment of all specific sores and for the dressing 
of indolent or sloughing ulcers. Benzoate of bismuth, when properly 
applied, should be preceded by a careful washing of the diseased sur- 
face with a very weak bichloride-of-mercury solution, after which the 
bismuth is to be sprinkled over the wound and the entire surface cov- 
ered with cotton, which should be held in place by an adhesive strip. 
The only disadvantage in this dressing lies in the fact that it has to 
be changed once or twice in every twenty-four hours. Immediately 
after it is applied it may produce some tingling or burning, but this 
is never very severe. 



BENZOIN AND BENZOIC ACID. 

Benzoin (Benzoinum, TJ. S. and B. P.) is a resinous balsam derived 
from the Styrax Benzoin, which is a native of Sumatra, Borneo, and 
Java. Benzoic acid is obtained by the sublimation of gum benzoin, 
or prepared artificially, chiefly from toluol. This last preparation is 
not to be recommended, as it often disorders the stomach and leaves 
a disagreeable taste in the mouth. It is benzoic acid which is gen- 
erally used in medicine. 

Physiological Action. — Locally applied in concentrated form, ben- 
zoic acid is an irritant, and taken internally in excessive amount it 
causes a sensation of warmth and burning. It is eliminated as hip- 
puric acid, and increases the acidity of the urine. On the lower forms 
of life it acts as an antiseptic and germicide. In persons having an 
idiosyncrasy to benzoic acid it is not uncommon for urticaria to follow 
the use of the drug. Sometimes a papular or erythematous eruption 
appears. 

Therapeutics. — Benzoic acid is useful in the treatment of chronic 
cystitis with alkaline urine wmich is loaded with phosphates, and, 



90 DRUGS. 

combined with cannabis indica, acts well in the later stages of gonor- 
rhoea. Senator states that in the dose of 2 or 3 drachms (8.0-12.0) 
a day it is a specific in acute rheumatism, and thinks it equal to sali- 
cylic acid. When these doses are to be used, the benzoate of sodium 
should be employed, owing to its solubility. In acute laryngitis 
accompanied by great hoarseness the inhalation of steam laden with 
compound tincture of benzoin is of the greatest service. A table- 
spoonful (16.0) of this tincture should be placed in a pitcher of boil- 
ing water, the face held over the liquid, and a towel thrown over the 
head of the patient to retain the steam. The drug cannot be used in 
an atomizer, as it clogs the "tips." Taken internally, benzoic acid 
is useful in chronic bronchitis. 

Administration. — The dose of benzoic acid (Acidum Benzoicum, 
TJ. S. and B. P.) is usually 10 to 40 grains (0.6-2.6), but a drachm 
may be given in capsule. The gum itself is never used as such. 
The tincture (Tinctura Benzoini, TJ. S.) is given in 30-minim to 1- 
drachm (2.0-4.0) doses, and the compound tincture (Tinctura Ben- 
zoini Oomposita, TJ. S. and B. P.) is composed of benzoin, aloes, sto- 
rax, balsam of Tolu, and alcohol, the dose of it being 1 to 2 fluid- 
drachms (4.0-8.0). The preparations official in the B. P., but not 
in the TJ. S. P., are the troches {Trochisci Acidi Benzoici) and 
Unguentum Cetacei. 

Adeps Benzoinatus ( TJ. S. and B. P.), or benzoated lard, is sim- 
ply a non-rancid basis for many ointments, notably that of zinc. 



BICARBONATE OF POTASSIUM. 

This salt (Potassii Bicarbonas, TJ. S. and B. P.) is used for the 
same purposes as the citrate and acetate of potassium, and, as it is 
much less agreeable in taste, should not be employed when they can 
be obtained. From the bicarbonate of potassium are made several 
very useful preparations : the liquor potassii citratis, by adding 120 
grains (8.0) to 90 grains (6.0) of citric acid and 10 ounces (320.0) of 
water; the neutral mixture, by adding to 1 pint (500.0) of lemon-juice 
enough of the potassium salt to neutralize it. The dose of potassii 
bicarbonas is 5 to 40 grains (0.3-2.6), or even as much as 2 drachms 
(8.0) may be given if well diluted with water. 



BICARBONATE OP SODIUM. 

Bicarbonate of Sodium (Sodii Bicarbonas, TJ. S. and B. P.) is a 
salt largely used as an antacid in gastric fermentation and in sick 
headaches arising from this condition. Combined with calomel in 
powder, it certainly adds to its efficiency in increasing biliary flow, 
as all alkalies of this class liquefy and thin the bile. The drug has 
been widely employed in the treatment of rheumatism, and is found 
to be of great service in allaying pain and soreness in the joints when 
used in a lotion made by dissolving it in water and applying it to the 
part on lint or rags. In acidity of the stomach the following effer- 



BISMUTH. 91 

vescing powder is useful : Bicarbonate of sodium (Sodii Bicarbonas), 
30 grains (2,0) in one paper, and in the other 20 grains (1.3) of tar- 
taric acid (Acidum Tartaricum). These are each dissolved in half a 
tumbler of water, added to one another, and swallowed during effer- 
vescence. 

BISMUTH. 

Bismuth (Bismuthum, B. P.) is official as the subcarbonate (Bis- 
muthi Subcarbonas, TI. S.), the subnitrate (Bismuthi Subnitras, U. S. 
and B. P.), the citrate (Bismuthi Citras, U. S. and B. P.), and the 
bismuth and ammonium citrate (Bismuthi et Ammonii Citras, TI. S. 
and B. P.). The first and second are identical in their dose (5 to 20 
grains) (0.3-1.3) and action, and may be employed interchangeably. 
The third and fourth are more astringent and more irritating than 
the other two, and must be given in a smaller dose, which is 2 to 4 
grains (0.1-0.2). Many years ago the drug was supposed to be cap- 
able of producing gastro-enteritis in large doses, but this was due to 
a contamination by arsenic. Bismuth may produce chronic poison- 
ing after prolonged use on wounds or when internally administered. 
The changes under these circumstances are the formation of black 
sloughs in the mouth and gastro-intestinal tract, desquamative nephri- 
tis, and albuminuria. The preparations of the B. P. not official in 
the TI. S. P. are the Liquor Bismuthi et Ammonii Citratis, dose J to 
1 fluidrachm (2.0-4.0), and the troches (Trochisci Bismuthi), 2 grains 
(0.1) in each. Bismuthi Carbonas, B. P., is the same as the subcar- 
bonate of the TI. S. P. 

Therapeutics. — Bismuth is used as an astringent in large doses to 
cover the surface of inflamed mucous membranes and so to allay irri- 
tation. It is useful in irritative vomiting for this reason, and in diar- 
rhoea of a similar type in which the stools are serous. If the passages 
are mucous, castor oil should precede bismuth in order to rid the ali- 
mentary canal of the mucous secretion already poured out. It is very 
useful when combined with carbolic acid in serous diarrhoea, given in 
capsules containing 5 grains (0.3) of bismuth subnitrate and 1 drop 
(0,05) of carbolic acid (Wood). It is also to be used as a slow and 
feeble antacid. The Bismuthi et Ammonii Citras is very astringent, 
and should be used in chronic serous diarrhoeas in the dose of 5 grains 
(0.3) every two or three hours. The other preparations of bismuth 
are insoluble, and they should not be given in water, but this prepa- 
ration is soluble and may be given in solution. Bismuth is of service 
in dyspepsia when lactic and butyric acid fermentation is present with 
excessive belching, and may be employed in gastralgia and gastric 
ulcer and gastritis as a sedative and astringent. Bismuth and ammo- 
nium citrate must never be employed if acute inflammation exists. 

When the salts of bismuth are used for any length of time, they 
cause the odor of garlic to appear in the breath, which is due to the 
presence of an exceedingly slight trace of tellurium in the bismuth. 
The stools are apt to become black, and the tongue, if furred, may 
also be black about the centre when bismuth is used. 



92 DRUGS. 

Where there is chapping of the hands or cheeks from exposure to 
cold or wet the following prescription is useful : 

R. — Bismuth i subnitratis giij (12.0). 

Zinci oleatis ^iij (12.0). 

Lycopodii , . . gij (8.0).— M. 

S. — Apply to the parts t. d. 



BISMUTH SALICYLATE. 
(See Salicylate of Bismuth.) 

BISMUTH SUBGALLATE. 

Dermatol, or the subgallate of bismuth, was first used by Heinz 
and Liebrecht. It is a fine yellow powder which is unaffected by 
long exposure to light and air, is entirely odorless, and is supposed to 
contain 5& per cent, of oxide of bismuth. Its external uses are iden- 
tical with the uses of iodoform, and it probably acts in much the 
same manner as does the latter drug — namely, by so drying the 
wound that it becomes an unfavorable soil for the growth of germs. 
As dermatol is an astringent, it cannot be employed in the treatment 
of indolent ulcers, which need stimulation rather than an astringent 
influence, and it would seem probable on theoretical grounds that it 
is not to be compared to iodoform in the treatment of cases in which 
tubercular processes are going on. 

There is no doubt that dermatol is less poisonous than iodoform, 
but it must be capable of producing some untoward effects if used 
profusely for any length of time, since poisoning follows the pro- 
longed employment of bismuth preparations, as has been determined 
by Balzer, Dalche, and Villejean, for the symptoms of which see the 
article on Bismuth. 

Dermatol may be tried in cases of skin disease in which there is 
much secretion, as in weeping eczemas and similar states, either in 
the form of a dusting-powder or in an ointment with vaseline or lano- 
lin in the proportion of J to 1 drachm to the ounce (2.0-4.0 : 36.0). 
Sometimes its efficiency can be much increased by the addition of an 
equal part of oxide of zinc to the prescription just given. 

Dermatol has been used in cases of purulent otitis media and many 
states requiring similar effects with marked success. 

Internally, it has been highly recommended in cases of fermenta- 
tive dyspepsia in the dose of 5 to 10 grains (0.3-0.65), but its real 
value in this condition is as vet undetermined. 



BITARTRATE OP POTASSIUM. 

Potassii Bitartras, U. S., Potassii Tartras Acida, B. P., is some- 
times called "cream of tartar" or acid tartrate of potassium. It is 
a white gritty powder which may occur in rhombic crystals. Owing 



BORAX AND BORTC ACID. 93 

to its stability, it has been thought that it escaped from the body 
without oxidation, and so to differ from the other potassium salts 
formed from vegetable acids. This is probably incorrect. 

Therapeutics. — The bitartrate of potassium is the most diuretic of 
the potassium salts, and is used in chronic nephritis with gin or com- 
pound infusion of juniper, when it is very useful in removing dropsy. 
1 ounce' (32.0) of the salt is added to a pint (500 cc.) of the infu- 
sion of juniper-berries, and the entire quantity taken in divided doses 
in twenty-four hours. In acute renal disease the drug should be used 
without the juniper. In large doses — J an ounce (16.0) — it acts as a 
watery purge, but is rarely so used. Where the urine is thick and 
alkaline bitartrate of potassium is a useful remedy to neutralize it 
and make it clear and normal in hue. 



BORAX AND BORIC ACID. 

Borax, or Sodii Boras (U. S. and B. P.), may be made by the 
action of boracic or boric acid upon soda, but the drug as it appears 
in commerce in America is derived entirely from natural deposits 
found on the shores of lakes in California and Nevada. The natural 
product is, of course, very impure, and has to be purified before it is 
marketable. Borax is soluble in twelve times its weight of water. 
Both borax and boric acid have been supposed to act as efficient 
germicides in strong solutions, but this has been proved incorrect. 
They are antiseptics, however, even when in weak solutions. In the 
form of a lotion boric acid has been used as a remedy for erysipelas 
with a good deal of success, and it may be similarly employed in 
burns and sccdds. Borax may also be used as a wash in diphtheria 
and in aphthous stomatitis, cancrum oris, and gangrenous stomatitis. 
Internally, borax has been used in epilepsy, and may be tried with 
some slight hope of a good result. (See Epilepsy.) In the treatment 
of pruritus ani and vulvae and in bromidrosis and foetid siveating it is 
of great value when used as a wash. Strong solutions, locally applied, 
are useful in tinea tonsurans and tinea circinata. Boric acid may be 
given internally in cystitis to render the urine acid, and is useful in 
the removal of freckles when applied as a wash to the skin. In per- 
sons having an idiosyncrasy to boric acid a bullous eruption of the 
skin may follow its use. 

Borax should not be used with glycerin, as an acid reaction is apt 
to occur. 

A very useful wash for oral and nasal mucous membranes is 
" Dobell's solution," which is composed of — 

B - - l°^ w Tat u *■ \ ™ 35 ( 4 -°)- 

vSodn bicarbonatis j *- J v ; 

Acid, carbolici gr. xxx (2.0). 

Glycerini f 5j (32.0). 

Aquae purse . Oij (1 litre). — M. 

Boric acid (Acidum Boricum, U. S. and B. P.) is one of the most 
commonly used substances in eye-washes, either alone or with cocaine. 



94 DRUGS. 

When used with cocaine or other drugs it is employed to prevent the 
destruction of the alkaloid or glucoside, as the case may be, by the 
growth of mould. The following formula may be employed : 

B. — Cocain. hydrochlor gr. iv vel viij (0.2-0.5). 

Acid, boric gr. x vel xx (0.65-1.3). 

Aqua? destillat f gij (64.0).— M. 

S. — To be used by dropping into the eye in conjunctivitis and similar states. 

Borax has been used very largely in the treatment of epilepsy, 
with asserted success in some cases. Its employment is purely empir- 
ical. The dose used is from 8 to 15 grains (0.5-1.0), gradually 
increased until it produces some disturbance in the alimentary canal. 
As the taste is very disagreeable to most persons, the drug should be 
used with liquorice, strong coffee, or syrup of bitter orange : 

R.— Sodiiboratis ^ss (16.0). 

Glycerin f,|j (32.0). 

Ext.glvcyrrhiz.il f^ij (64.0). 

Aquse *. q. s. f gvj (128.0).— M. 

S. — Dessertspoonful (8.0) in water after each meal. 

If larger doses than 15 to 30 grains (1.0-2.0) a day are used after 
the convulsions are decreased in number, there are two difficulties : 1st, 
that the good effect is rapidly lost ; and, 2d, that untoward symptoms, 
such as nausea and diarrhoea, with emaciation and the formation of a 
scarlatinal, eczematous, or papular eruption, appear. A peculiarity 
of the last two eruptions is that they are distributed around the joints. 

The following makes a very useful application for the skin of the 
face and hands to prevent chapping : 

B .—Acid, boric £j (4.0). 

Ceraealbse gj (4.0). 

Paraffini ^ij (8.0). 

01. amygdalae dulc f^ij (8.0).— M. 

S. — To be thoroughly mixed and applied night and morning. 

Potter recommends the following in uric-acid diathesis when there 
is a tendency to the formation of stone : 

B. — Magnesii carbonatis 3J (4.0). 

Acid, citrici £ij (8.0). 

Sodii borat. . ■ ^ij (8.0). 

Aquae bullientis f^viij (240.0).— M. 

S. — A tablespoonful t. d. 

Or, 

R— Acid, boric 3j (4.0). 

Potassii bitartrat £iv (16.0). 

Aquae q. s. ad f^x (320.0).— M. 

S. — Heat together to dryness, and give 20 grains in water, well diluted, t. d. 

Borated lint is made by dipping lint into a boiling saturated solu- 
tion of boric acid or borax. It makes a simple, inexpensive anti- 
septic surgical dressing, and contains nearly one-half its weight of 
the drug. G-lycerinum Boracis, B. P., and Mel Boracis, B. P., are 
not official in the U. S. P., but are used as local applications for 
chapped hands and small sores. 



BROMIDES. 95 

BOROGLYCERIN. 

Boroglycerin is a liquid made by mixing 62 parts of boric acid with 
92 parts of glycerin in a tarred porcelain capsule at a temperature of 
not more than 302° F. The acid is added to the glycerin gradually, 
with constant stirring. When the mixture has been reduced to the 
weight of 100 parts, it is poured on a flat surface wet slightly with 
petroleum, and on hardening is cut into blocks, which shouid be placed 
at once in a well-stoppered bottle. When used for medicinal purposes 
the glycerite of boroglycerin (Glyceritum Boroglycerini, U. S.) should 
be employed, which may be made by adding 1 ounce (32.) of the boro- 
glycerin in solid form to 1 ounce (32.) of glycerin and heating in a 
dish while stirring. It is soluble in water. Locally the glycerite of 
boroglycerin is used as an antiseptic and as a vehicle for carbolic 
acid, chrysarobin, and the vegetable alkaloids in the treatment of 
skin diseases, and in diseases of the eye, such as purulent ophthalmia. 



BROMIDES. 

Bromides of Potassium, Sodium, Lithium, Calcium, Gold, Nickel and 
Ammonium, and Hydrobromic Acid. 

Bromide of Potassium. 

Bromide of Potassium (Potassii Bromidum, U. S. and B. P.) is 
the most commonly used and important member of the group above 
named, and will, therefore, be spoken of before the others. 

It is prepared by precipitating freshly-made bromide of iron with 
pure carbonate of potassium, or by a process more readily carried out 
and recommended by the B. P. It occurs in colorless transparent 
crystals, which are stable in dry air, but absorb moisture in a damp 
atmosphere. It is very soluble in water, but less so in alcohol. This 
bromide has a salty taste, and is distinctly irritant to mucous mem- 
branes if locally applied in concentrated form. 

Physiological Action. — Bromide of potassium has an action upon 
the animal economy which is clearly defined and closely followed by 
all the other bromide salts, so that what is said in this place concern- 
ing its effects may be taken as representing the whole class of bromides, 
except in the instances where slight differences exist, which will be 
pointed out under the various names of the respective salts. 

Xervous System. — The bromide of potassium acts as a distinct 
depressant to the motor and intellectual portions of the cortex cerebri. 
It slows the development of thought and decreases the excitability 
and power of the motor cells of the brain (Albertoni). Upon the 
spinal cord it acts as a marked sedative, affecting chiefly the sensory 
tracts, and causing thereby loss of reflex action and a decrease in 
the ability of the animal to recognize pain. It also depresses to a 
less extent the motor pathways in the cord. Motion is maintained 
after sensations to pain and reflexes are lost. The drug depresses 



96 DRUGS. 

the peripheral parts of the sensory nerves, and in very large doses 
the motor nerves and muscles are similarly involved. 

Circulation. — If the drug be injected in ordinary dose into the 
jugular vein, it causes at once a fall of arterial pressure and pulse- 
rate. These changes are due to a direct action of the bromine and 
the potassium upon the heart. When given to man in therapeutic 
doses by the mouth, its circulatory effect is so slight as not to be 
worthy of consideration. 

Respiration. — Bromide of potassium is a depressant to the res- 
piratory centre in toxic dose. In medicinal dose it does not affect 
the breathing, except when the amounts given are large and the drug 
persistently administered, when the breathing becomes slower. 

Temperature. — No effect upon this function is noted unless the 
dose be enormous : when such a dose is given the bodily heat is pro- 
gressively diminished, the fall of temperature being probably due to 
the circulatory and nervous depression produced, associated with the 
general failure in vital power. 

Elimination. — The drug escapes unchanged very slowly with all 
the secretions, and is found in the sweat, urine, tears, semen, milk, 
and fseces. 

Tissue-waste is decreased. 

Therapeutics. — From what has been already said, it is evident that 
bromide of potassium is a remedy to be devoted almost entirely to the 
treatment of diseases of the nervous system, and its uses are, therefore, 
as various as the manifestations of perversion of nervous action can 
be various. In a word, it may be said that bromide of potassium is 
to be used wherever over-excitement of nervous protoplasm is present, 
but never where nervous symptoms are due to depression. 

In epilepsy, which, to the best of our knowledge, is due to explosive 
impulses arising in the cerebral cortex, it is the best drug we have, 
and in all forms of minor spasm, due to heightened reflex activity, it 
is of service. (See Epilepsy, Part IV.) In spasmodic contractions, 
in the treatment of hysterical females, in nervous starlings and alarm 
at sudden noises in adults and children, and in the nervous symptoms 
accompany pregnancy and the menopause it will be found of great 
value. The following prescription is recommended very highly by 
Goodell, and will be found of service in these states : 

R. — Ammonii bromidi 3y (8.0). 

Potassii bromidi ^iv (16.0). 

Spts. ammon. aromat f^vj (24.0). 

Aqnse camphorse . q. s. ad fjvj (192.0). — M. 

S. — A dessertspoonful (8.0) to a tablespoonful (16.0) every four hours. 

In headaches due to uterine trouble the pain is often felt at the top 
of the skull or at the back of the neck near the occiput. The cause 
of this trouble will sometimes be found to be in the cervix uteri, and 
relief under these circumstances can only be obtained when the uterus 
is treated and the bromides administered. 

In convulsions in children and adults, combined with chloral, bro- 
mides are most efficient, and are sometimes of service in incontinence 
of urine due to vesical spasm. In seminal emissions due to a morbid 



BROMIDES. 97 

excitability of the centres in the spinal cord bromide of potassium is 
one of the best remedies we have, and in satyriasis and nymphomania 
it is of great service. 

In cases where undue irritability of the pharynx and larynx prevents 
examination of these parts, one or two full doses will render an exami- 
nation easy of performance by decreasing the local reflex activity. 
This is a useful point to be remembered in relation to the treatment 
of pharyngeal and laryngeal disease. 

In cases of acute laryngitis full doses of the bromides (60 to 120 
grains [4.0-8.0] a day) are very useful. 

The bromides are found to be of service in the laryngeal crises of 
locomotor ataxia, the explanation of this fact being as follows : The 
adductor centre of the larynx is situated in the brain, and the abduc- 
tor centre in the spinal cord. The first closes the larynx, the second 
opens it, and in health they maintain a patulous tube by their oppo- 
sition. In disease the spinal centre (the abductor or opener) fails, 
and the adductor in the brain being unopposed, produces closure of 
the tube with disastrous results. The bromide, by quieting reflex 
action, as well as depressing the adductor centre in the cerebral cor- 
tex, prevents this accident. 

In whooping cough with much mucous exudation the drug is rarely 
of benefit, and had better not be used. In laryngismus stridulus or 
any form of spasm depending upon local irritation the local trouble 
must, of course, be removed if possible. In teething the drug may be 
used to decrease reflex irritation and prevent convulsions, and it will 
decrease the night-screaming of children — which is often due to bad 
dreams — to a very extraordinary degree, even if the dose be quite 
small. As a soporific for the insane and in the insomnia of the over- 
worked and that of nervous women the bromide of potassium is of 
great service. It may also be employed with good results in chronic 
alcoholism and morphiomania. In migraine and neuralgia due to eye- 
strain or other nerve-strain, combined with caffeine the bromide is 
almost a specific. The caffeine seems to stimulate the depressed nerve 
up to the normal level, and the bromide to deaden the perception of 
the pain. The following is a most valuable remedy in migraine, and 
even ir. sick headache. It ought not to be used in bilious headache, 
which will often be made worse by it : 

R . — Antipyrini gr. xxv (1.65). 

Caffeinee citratae gr. x (0.65). 

Potassii bromidi gr. xxv (1.65). — M. 

Ft. in chart No. v. 
S. — One powder as needed. 

In the treatment of dysmenorrhea and menorrhagia 1 particularly 
in young subjects, the bromides are also of service. (See Dr. Groodell's 
prescription just given.) When the flow is too great at such a period, 
the drug should be begun a week before the expected epoch, and kept 
up in the dose of 5 to 10 grains (0.3-0.65) night and morning. In 
cases where the epochs follow one another too closely the drug should 
be used continuously. After an apparent cure ensues the bromide 

7 



98 BR UGS. 

should be used for a few periods to avoid a relapse. For seasickness 
the bromides are the best prophylactics we possess, and should be 
used in the dose of 5 to 10 grains (0.3-0.65) three times a day for 
several days before the patient sails in order to quiet the vomiting 
centre. After sea-sickness begins they should not be given in ordi- 
nary solution, but in an effervescing draught made as follows : 

R.— Acid, citric £ij (8.0). 

Aquae dest . f giv (128.0).— M. 

Ft. sol. 

R. — Potassii bromidi gj (4.0). 

Potassii bicarbonatis . . . 3j (4.0). 

Aquae dest f^iv (128.0).— M. 

Ft. sol. 
S. — A tablespoonful (16.0) of each of these solutions should be added to one another 
and taken during effervescence. 

This prescription will also be found of value in the persistent vom- 
iting of pregnancy and in that following prolonged etherization or 
other states. If the vomiting is excessive, the dose ought to be 
reduced to 2 teaspoonfuls (8.0) of each solution, and be given every 
half-hour until half of each mixture is taken or the patient is relieved. 
In cases where this will not act rectal injections of the following will 
be found of value : 

R. — Potassii bromidi gr. xxx (2.0). 

Tinct. opii deodorat gtt. xxx (2.0). 

^ Aquae amyli . ^ f^vj (192.0).— M. 

S. — To be injected gently into the empty rectum and retained as long as possible. 

This method is the most reliable plan that can be followed. 

Bromide of potassium may be used to prevent the symptoms of 
cinchonism after the use of quinine and salicylic acid, and it is said to 
prevent the nausea and depression so apt to follow the use of opium. 

Administration. — The dose of bromide of potassium is from 5 to 
120 grains (0.3-8.0) a day. 

Use of Bromides in Poisoning. — Bromides are useful in all convul- 
sive attacks consequent upon the ingestion of poisons, except those 
due to cardiac sedatives which depress the circulation at the base of 
the brain, and they may be used to allay any nervous symptoms which 
are of an excited nature, to prevent excessive vomiting, to produce 
sleep, and to quiet delirium, and even to allay pain. 

Effects of Prolonged Use. — After the drug has been used for some 
time acne appears about the face and extends over the entire body, 
the breath becomes foetid, the patient dull, expressionless, and heavy, 
remaining buried in sleep during nearly every hour of the day. Dur- 
ing this time he can be aroused, but at once falls to sleep again. The 
walk becomes weak and feeble, the movements slow and painfully 
prolonged. Taste is lost and hearing is benumbed, while the intel- 
lectual faculties of the brain are almost blank. Loss of sexual power 
is an early symptom. The acne may be put aside by the use of 
arsenic, and where bromides are used to any extent in women this 
drug should always be given simultaneously to prevent the eruption 



BROMIDES. 99 

As Fowler's solution is compatible with the bromide in solution, it is 
the best form of arsenic to employ. 

Bromide of Ammonium. 
(See Ammonium Bromide.) 

Bromide of Calcium. 

Calcium Bromide (Oalcii Bromidum, U. S.) was introduced into 
medicine as a nervous sedative and hypnotic, and was thought at one 
time to be an efficient substitute for the bromide of potassium. Its 
action on the nervous system is virtually identical with that of the 
potassium salt, and it has been found to be far less irritant and 
depressant than the latter. For some unknown reason it has never 
won the confidence of the profession, but it may be given with very 
good results in the dose of from 30 to 90 grains (2.0-6.0) a day, or 
even more in cases which are not readily affected by bromides. It is 
employed especially in hysteria and epilepsy and in all the conditions 
in which the other bromide salts are indicated. It is sometimes of 
value combined with the potassium salt, since under such circumstances 
better results are gained than if a single salt is employed. 

Bromide of Gold. 

The Bromide of Gold has been employed in epilepsy by a number 
of clinicians with great success in the dose of from ^ to \ grain 
(0.015-0.03) three times a day in pills. Physiological studies have 
proved that the drug is a direct sedative to the motor cells in the 
cortex cerebri. 

Bromide of Lithium. 

Bromide of Lithium (Lithii Bromidum, U. S.). This salt is much 
weaker than the other salts, and may be given in larger dose. Dr. 
S. Weir Mitchell states that it is of value in epilepsy after the potas- 
sium salt fails. The dose is 30 to 90 grains (2.0-6.0) a day. 

Bromide of Nickel. 

This is a green salt quite irritant to the stomach. The author has 
made an experimental study of the bromide of nickel, and found it 
practically identical with the bromide of potassium in physiological 
action. It should be given well diluted or in an effervescing draught, 
as it is apt to disorder the stomach if used in concentrated solution. 
The effervescing form of the drug is made by mixing the salt with 
bicarbonate of sodium and tartaric acid, moistening with alcohol, 
passing the moist powder through a sieve, and then drying it in a 
warm closet. 

Bromide of Sodium. 

Bromide of Sodium (Sodii Bromidum, U. S. and B. P.). This 
salt is to be used in every instance where bromide of potassium can 



100 DRUGS. 

be employed. Its dose is the same, although it is asserted to be a 
little weaker physiologically, grain for grain, than the potassium salt. 
It is far less apt to disorder the stomach, and is not so generally 
depressant as is the bromide of potassium. 

Hydrobromic Acid. 

Hydrobromic Acid is an extremely irritant preparation, but is 
thought to be less apt to cause acne and other untoward effects than 
the other bromides. It is only to be used in the form of the official 
dilute acid (Acidum Hydrobromicum Dilutum, U. S. and B. P.), and 
to be given in the dose of from 1 drachm to \ an ounce (4.0-16.0) 
well diluted with sweetened water. It is highly recommended by 
Be Schweinitz and others for headaches due to eye-strain in nervous 
women. 



BROMIDE OP ETHYL. 

(See Ethyl Bromide.) 

BROMIDE OP STRONTIUM. 

(See Strontium.) 

BROMINE. 

Bromine ( U. S. and B. P.) is a dark-red liquid of an excessively 
pungent odor, like that of chlorine, possessing very extraordinary 
power as a caustic when applied to the tissues of the body. It is the 
most severe caustic we possess, and penetrates very deeply. It may 
be applied in hospital gangrene and other large sloughs by means of 
a glass-rod. Bromine should be kept in glass-stoppered bottles in a 
cool place. 

BROMOPORM. 

Bromoform, or Tribromomethane, is a clear, colorless liquid hav- 
ing a peculiar odor and sweet taste. It is readily soluble in alcohol, 
but slightly so in water. Bromoform, which is to be used medicinally, 
should be protected from sunlight and air, and must be free from 
color and from acid. 

, Therapeutics. — Although bromoform has been found capable of 
producing anaesthesia when given by inhalation, its employment in 
medicine is practically confined to the treatment of whooping cough, 
when it is given internally in the dose of 2 to 5 drops (0.1-0.3) three 
times a day for the relief of the spasmodic cough. Bedford has sug- 
gested the following formula for its internal use : 



BRYONIA, OR BRYONY. 101 

R. — Bromoform. Tr lxvj (1.0). 

Alcohol f gij (8.0). 

Glycerin _ f 3xij (48.0). 

Tinct. cardamomi comp. . . . q. s. ad f^ij (64.0). — M. 
S. — Teaspoonful (4.0) t. d. in water. 

This prescription should be put up by adding the ingredients in the 
order named. 

Bromoform tends to depress the vasomotor system, but does not 
seem to depress the heart itself. 



BRYONIA, or BRYONY. 

This is a remedy very largely used by irregular physicians, but 
which nevertheless possesses very great power, and often relieves con- 
ditions which are obstinately persistent under other treatment. It is 
the root of Bryonia Alba or Bryonia Dioiea ( JJ. S.). The only official 
preparation is the tincture (Tinctnra Bryonia?, U. S.). The dose of 
the powdered root as a drastic is 10 to 40 grains (0.6-2.4). 

Physiological Action. — In overdoses bryonia acts as a hydragogue 
cathartic and gastro-intestinal irritant. On serous membranes it 
exercises an irritant influence, and may produce symptoms of menin- 
gitis when given in poisonous doses. In moderate doses bryonia 
may cause some flushing of the face and neck and headache in sus- 
ceptible persons. The drug needs studying from a physiological 
point of view. 

Therapeutics. — Although one of the oldest of remedies, bryonia 
has been given a new impetus by the homoeopaths, who employ it in 
a number of affections. In the treatment of dyspepsia depending 
upon gastric and intestinal atony or the abuse of alcohol or other 
similar causes bryonia often gives relief. Its influence is exerted 
through the irritant effects it produces, for by this means it stimulates 
or spurs the atonic digestive glands to increased activity. For this 
reason it has been found to be particularly useful in children who 
suffer from constipation resulting from insufficient secretion on the 
part of the intestinal glands. When the passages are dry and friable 
and resemble those of a dog in character, bryonia is of great value. 
The drug has been praised as a remedy in the treatment of rheuma- 
tism and in pleurisy, but little is recorded as to its real value in these 
diseases. It is probably always more effective when the febrile stages 
of these affections have passed by. Thus in pleurisy it is useless 
during the acute, forming stage, but prevents the pouring out of effu- 
sions, and if they be already poured out aids in their absorption. 

Administration. — The dose of the tincture of bryonia {Tinctura 
Bryonia?, TJ. S.) is from 1 to 2 fluidrachms (4.0-8.0) as a laxative, but 
the so-called mother-tincture of the homoeopaths is perhaps the best 
preparation for ordinary use. The proper amount to be used in the 
treatment of a case of dyspepsia is from 5 to 40 drops (0.3-2.4) unless 
the mucous membranes are very torpid, when this quantity may be 
increased. In pleurisy with effusion drastic doses may be needed, 
but the saline purgatives are safer and more efficacious. 



102 DRUGS. 

BUCHU. 

Buchu (Z7. S.) is derived from Barosma Betulina, a plant of 
Africa. It contains a volatile oil, which is probably the active prin- 
ciple, and a bitter extractive. It is official, under the name of Buchu 
Folia, in the B. P. 

Therapeutics. — Buchu is used as a diuretic when it is desired to 
affect the mucous membranes of the genito-urinary tract which are 
chronically diseased, and particularly when these parts are below 
their normal tone. It does not increase the urinary flow to any great 
extent, but acts on the genito-urinary passages as a stimulant. It is 
useful in pyelitis, cystitis, and vesical irritation of a chronic type. 
The following prescription is useful : 

R. — Potassii citratis £iv (16.0). 

Spt. chloroformi f^iij (12.0). 

Tinct. digitalis f£j (4.0). 

Infusi buchu f Jviij (256.0).— M. 

S.— Two tablespoonfuls (32.0) three times a day. 

If the urine is continually highly acid, muddy, laden with salts, 
and productive of incontinence by reason of the vesical irritation 
which it produces, buchu in the form of the fluid extract, in the dose 
of a teaspoonful (4.0) three times a day, combined with an equal 
amount of sweet spirit of nitre, will be of great service. For a child 
the dose of the fluid extract should be about 10 to 30 minims (0.6— 
2.0). If the vesical irritation is acute, buchu is contraindicated. 

Administration. — The fluid extract (JExtr actum Buchu Fluidum, 
U. S.) is the only official preparation, and it should be always well 
diluted before it is given, in the dose, to an adult, of 1 drachm (4.0) 
three times a day. The infusion is not official, but is made by add- 
ing 1 ounce (32.0) of the leaves to a pint (500 cc.) of water. The 
dose of this is a tablespoonful (16.0) to two tablespoonfuls (32.0). 
The official B. P. preparations are the infusion (Infusum Buchu), 
dose 1 to 4 fluidounces (32.0-128.0), and the tincture {Tinctura 
Buchu), dose 1 to 2 fluidrachms (4.0-8.0). 

CACTUS GRANDIFLORUS. 

This is a plant of Mexico and the West Indies. There are other 
species possessing medicinal power, but the Cactus grandiflorus is the 
most active. 

The drug is best given in the form of the tincture or the fluid 
extract made from the green plant. 

Physiological Action. — This has been studied by Myers and Boinet 
and Teissier, who have found that the drug causes a distinct increase 
of arterial pressure, but does not slow the pulse, sometimes increasing 
its rapidity. Myers has also shown that the drug is a stimulant to 
the vasomotor centres and to the motor ganglia of the heart-muscle. 
Cactus grandiflorus also acts as a stimulant rather than a depressant 
to the spinal cord. 

Therapeutics. — Cactus grandiflorus bids fair to prove itself a good 



CAFFEA. 103 

substitute for digitalis in certain diseases of the circulatory apparatus, 
such as cardiac palpitation and weakness. It has also been found 
very serviceable as a remedy in cardiac failure the result of valvular 
disease, but in all such cases seems to act best when added to some 
more powerful drug, such as digitalis, as it takes the part of an 
adjuvant. Cactus also acts well in some cases of angina pectoris. 

Administration. — The dose of the tincture of cactus is 2 to 8 minims 
(0.1-0.4) and of the fluid extract 2 to 4 minims (0.1-0.2). 

Untoward Effects. — It is claimed that these do not occur, and that 
the drug never produces a cumulative effect. 

CAFFEA. 

Caffeine (Caffeina, U. S. and B. P.) is an alkaloid derived from 
the berries of Caffea Arabiea, which also contain, upon roasting, an 
empyreumatic oil, caffeol or caffeone. Caffeine is usually employed 
in medicine as caffeine and the citrated caffeine (Caffeinee Citrata, 
U. S.), which is soluble in 75 parts of water. 1 Citrated caffeine is 
not regarded by chemists as a chemical compound ; therefore citrate of 
caffeine is an incorrect term. It is soluble in 3 parts of water. If 
more water is added, it is partly precipitated, but when 25 parts are 
added it is redissolved. In the U. S. P. for 1890 another official prep- 
aration of caffeine, the Caffeina Citrata Effervescens, has been intro- 
duced as an agreeable preparation in cases of headache if combined with 
one of the bromides and antipyrine. The dose is from 1 to 4 drachms. 

Physiological Action. — On the nervous system caffeine acts as a 
rapidly-acting stimulant, exerting its chief influence on the brain 
and spinal cord. By its cerebral effect it causes increased rapidity 
of thought, and by its influence on the spinal cord it increases reflex 
activity, and for this reason is said to make people "nervous." It is 
important to remember that it has no effect on brain protoplasm except 
to stimulate it, and that ultimately a brain driven along by caffeine 
breaks down by the concentration of its energy for the time being 
in one effort. 

Cikculation. — Caffeine has been supposed to increase the pulse- 
rate and blood-pressure by stimulating the heart-muscle, but from 
recent studies in this country and abroad it would seem probable that 
these changes are indirectly produced and due solely to its stimulating 
action on the nervous system. Clinically, it certainly seems to raise 
the blood-pressure in almost every instance where it is used. 

Kidneys, Tissue-waste, and Elimination. — Caffeine increases 
diuresis by a direct stimulation of the secretory epithelium of the 
kidney, and therefore increases the amount of solids as well as of the 
liquids in the urine. Upon tissue-waste the drug acts as a depressant, 
and is therefore a conservator of the tissues. It is burnt up in the 
body. 

1 Theine, derived from tea, caffeine, the active principle of coffee, and the alkaloid 
of gnarana from South America, are chemically identical. Much of the caffeine of 
commerce is really theine, although it is claimed that pure theine has a very different 
physiological action. 



104 DRUGS. 

The enipyreumatic oil, of which there is about one-half to one tea- 
spoonful in each well-made breakfast cup of coffee, has no physiological 
effects. It is probably the cause of the "biliousness " sometimes pro- 
duced by the habitual use of coffee, due to the faulty digestion of this 
oil, which is also apt to disorder the digestion if taken alone. 

Therapeutics. - — Caffeine is a valuable cardiac stimulant and tonic 
as well as a renal stimulant. It acts equally well in cardiac and renal 
dropsies for this reason, and is an invaluable remedy in such cases. 
In acute renal inflammation it is contraindicated, because all stim- 
ulants are contraindicated in acute inflammations. In -opium poison- 
ing, owing to its stimulant effect on the respiratory centre, it is very 
valuable. Under these circumstances it may be given in the form of 
strong black coffee, which will aid in keeping the patient awake and 
also add heat to the body, which is often very cold. A cup of strong 
black coffee is often useful in the treatment of a paroxysm of asthma. 
In headache due to nerve-strain caffeine combined with antipyrine 
and one of the bromides is of the greatest service. (See Neuralgia.) 
So useful is caffeine in cases of cardiac disease that it has largely sup- 
planted digitalis in the hands of some practitioners. 

Caffeince, TJ. S. and B. P., cannot be used hypodermically, owing 
to its decomposition in the presence of water. The following solution 
may, however, be used hypodermically : Salicylate of sodium, 30 parts ; 
caffeine, 40 parts ; and distilled water, 60 parts ; or, in other instances, 
the following preparation, recommended by Huchard, may be employed : 
Benzoate of sodium, 45 grains; caffeine, 30 grains; distilled water, 1J 
drachms. This mixture is to be heated, and 10 drops given at a dose. 

Untoward Effects. — Caffeine often produces so much insomnia when 
given in cardiac disease that it has to be discontinued. If its use is 
persisted in, it may produce a condition of delirium closely resembling 
that of alcoholism. The writer has also seen a marked rise of tem- 
perature follow its use in the dose of 2 grains (0.1) three times a day, 
but this is very unusual. 



CAJUPUT OIL. 

Oil of Cajuput {Oleum Cajuputi, TJ. S. and B. P.) is a volatile oil 
distilled from Melaleuca Leucodendron, a tree of the Molucca Islands. 
It is a stimulant, and in large amounts an irritant, to mucous mem- 
branes, but acts as an efficient carminative and parasiticide in mod- 
erate amounts. As a remedy for tinea tonsurans and jiediculi it should 
be applied pure to the part affected. Cajuput oil is capable of irri- 
tating the skin. In diarrhoea of a serous type it is of value in the 
dose of 10 to 20 drops (0.65-1.20). (See Diarrhoea.) Spiritus Cajuputi 
is official in the B. P. ; dose J to 1 fluidrachm (2.0-4.0). 



CALCIUM. 

Calcium is official in a number of forms, and is to be distinctly 
separated in the mind of the student from calx or lime, which is an 



CALCIUM. 105 

oxide of calcium. It is never employed as calcium, but as one of its 
salts. These are as follows : Bromide of calcium (Calcii Bromidum, 
U.S.); precipitated carbonate of calcium (Calcii Carbonas Precipi- 
tatus, U. S. ; Calcii Carbonas Precipitata, B. P.) ; chloride of cal- 
cium (Calcii Chloridum, U. S. and B. P.); hypophosphite of cal- 
cium (Calcii Hypopliosphis, U. 8. and B. P.)', and as precipitated 
phosphate of calcium (Calcii Phosphas Precipitatus, U. S. ; Calcii 
Phosphas Prcecipitata, B. P.). Calcium sulphate is not official. 

All salts of calcium are incompatible with acids. 

The precipitated carbonate of calcium is used in the treatment of 
serous diarrhoea as an antacid, and as a local protective in cases of 
chapped skin or intertrigo, particularly in young children. When 
given internally the dose is from 10 to 30 grains (0.65-2.0), but by 
far the best method for its administration is in the employment of 
chalk mixture (Mistura Cretw, U. S. and B. P.), which contains about 
30 grains of the chalk to each ounce (2.0-32.0) of liquid. The dose 
of this mixture is from a teaspoonful (4.0) for a young child to an 
ounce (32.0) for an adult. In the treatment of cases of diarrhoea 
chalk mixture is best given in combination with tincture of kino or 
the compound tincture of catechu and paregoric, in some such form 
as follows : 

R.— Tr. kino f&(32.0). 

Tr. catechu comp f^ij (8.0). 

Misturse cretae . . . q. s. ad f^vj (192.0). — M. 

S. — A dessertspoonful (8.0) every three hours till diarrhoea ceases. 

It is to be remembered that the chalk mixture acts very slightly 
as an astringent, and chiefly as an antacid and mechanical agent in 
the alimentary canal. 

Precipitated carbonate of calcium is the slowest antacid which we 
possess, and for this reason is the remedy to be employed in acidity 
of the intestines, as it passes through the stomach to a very great 
extent unchanged. (For the varieties of diarrhoea in which it is to 
be used see article on Diarrhoea.) As an external application it is 
used in sweating of the feet and hands, and sometimes as a dry dress- 
ing to ulcers. It may also be used over burns. 

Calcium chloride, when taken internally in any amount, acts as an 
intense gastro-intestinal irritant, and may produce death by this means. 
It is to be distinctly separated from the chlorinate or chloride of lime, 
with which it is sometimes confused, for the latter is nothing more 
than hydrate of lime or slaked lime, containing 25 per cent, of chlo- 
rine, while chloride of calcium is a hard, vitreous, friable substance, 
giving off* no odor of chlorine and utterly different in its use, action, 
and appearance. 

Chloride of calcium is used in medicine by some physicians in the 
treatment of scrofulous enlargements of glands in the neck and else- 
where, and is even said to cause calcification and encysting of tuber- 
cular nodules. In cases where deficient bone-formation is evident it 
often does good, but the other salts of lime, such as the lactophos- 
phates, are better. In cases where boils mature slowly a poultice 



106 DRUGS. 

made by adding a solution of chloride of calcium to the mass may be 
used to hasten suppuration. The dose internally is 5 to 30 grains 
(0.65-2.0), best given in a solution made by adding water in the pro- 
portion of 1 drachm (4.0) to each 5 grains (0.3) of the drug. 

The hypophosphite of calcium and the precipitated phosphate of 
calcium are used for the treatment of scrofulosis or strumous states 
and allied conditions, such as rachitis, generally in the form of the 
Syrupus Hypophosphitum, U.S., and the Syrupus Calcii Lactophos- 
phatis, U. S. 

The large amount of phosphate of calcium in the bones and tissues 
renders it a useful drug when the body is starved of its proper pro- 
portions of salts, and its use has been found, in animals, to cause a 
great increase in bony growth, not only in the earthy, but also in the 
animal, constituents of the osseous tissues. The hypophosphite has 
a similar effect. 

In rickets and in fractures where the bone is slow in uniting, and 
in some cases of phthisis and scrofula, the lactophosphates and hypo- 
phosphites are of service. It is worthy of note that they are of little 
value in tuberculosis after it is really well developed. They do good 
chiefly in the so-called pre-tubercular or beginning stages of the dis- 
ease. In dental caries, particularly that occurring in nursing women, 
and in the anosmia of this class of patients, they are useful. In gen- 
eral debility and nervous prostration they are often of great value, and 
may be even used with benefit in chronic and atonic diseases of the 
skin and mucous membranes. In cases of hepatic torpor they may be 
employed with advantage. 

The lactophosphates are better than the hypophosphites, as the 
latter are probably changed into phosphates in the stomach as soon 
as they enter that viscus. The only advantage which they possess over 
phosphorus in certain diseases, particularly those of the bony system, 
is that they afford an easy method of administration, and also that 
they contain calcium. The dose of either of these two drugs is 10 to 
30 grains (0.65-2.0) three times a day, or of the syrups just named 
a teaspoonful to a tablespoonful (4.0-15.0). The difference between 
these salts and phosphorus, both in therapeutical effect and physio- 
logical action, is to be clearly borne in mind. The lactophosphates 
and hypophosphites are simply convenient modes of administering 
calcium, potassium, or other substances, while phosphorus acts as a 
stimulant to bone-growth and not by its deposition in the bone. Phos- 
phoric acid does not act any more like phosphorus than does sulphuric 
acid act like sulphur. 

Sulphate of calcium is not to be confounded with sulphide of cal- 
cium, or, to speak more correctly, calx sulphurata. Very often fail- 
ure attends the use of this remedy, because the calx sulphurata has 
undergone oxidation and is calx sulphate. (See Boils and Calx.) 

Chalk. 

Chalk is a native calcium carbonate chiefly obtained from shells. 
Prepared chalk (Creta Prceparata, U. S. and B. P.) is given in the 



CALX. 107 

dose of 20 to 60 grains (1.3-4.0). Other preparations are compound 
chalk powder (Pulvis Cretce Compositus, U. S.), composed of prepared 
chalk, acacia, and sugar, and given in the dose of 10 to 60 grains 
(0.65-4.0), and troches of chalk (Trochisci Cretce, U. S.). Prepara- 
tions official in the B. P., but not in the U. S. P., are aromatic pow- 
der of chalk {Pulvis Cretce Aromaticus), dose 10 to 60 grains (0.65- 
4.0), and Pulvis Cretce Aromaticus cum Opio, dose 10 to 60 grains 
(0.65-4.0). 

CALUMBA. 

Calumba, Columbo, or Columba, is the root of the Jateorrhiza Pal- 
maia. Its taste is bitter and its odor is slightly aromatic. Two alka- 
loids are found in it, berberine and columbine, and a third substance 
known as columbic acid. Calumba is one of the purest bitters known. 

Therapeutics. — Calumba is one of the best simple tonics which can 
be used, owing to its lack of astringent effect and to its favorable 
action on mucous membranes. 

In cases of g astro-intestinal atony, particularly that following 
fevers and similar states, calumba will be found of service, and it is 
a valuable remedy in the convalescent stages of summer complaint 
and serous diarrhoeas. The following prescription of Dr. George B. 
Wood is very useful in these states when they are associated with 
flatulence : 

R.— Calumbae pulv ^ss (16.0). 

Zingiberis pulv ]|ss (16.0). 

Sennas fol 3J (4.0). 

Aquse bullientis Oj (500 cc). — M. 

Ft. in infnsum. 
S. — A wineglassful t. d. 

Administration. — The fluid extract (Pxtractum Calumbce Fluidum, 
U. S.) is given in the dose of 15 to 60 minims (1.0-4.0): the tinc- 
ture (Tinctura Calumbce, U. S.), dose 1 to 4 fluidrachms (4.0-16.0). 
The dose of the extract (Extractum Calumbce, B. P.) is 2 to 10 grains 
(0.1-0.65) ; the infusion (Infusum Calumbce, B. P.), 1 to 2 fluidounces 
(32.0-64.0); and the tincture (Tinctura Calumbce, B. P.), J to 2 
fluidrachms (2.0-8.0). 

CALX. 

Calx, or Lime, or Oxide of Calcium, is an alkaline earth which is 
incompatible with acids, ammoniacal and metallic bases, borates, alka- 
line carbonates, and astringent vegetable infusions. It is prepared 
by burning pure white marble, oyster-shells, or the purest calcium 
carbonate. 

Therapeutics. — Lime is used for the purpose of acting as an eschar- 
otic, particularly on old ulcers and on hairy growths. It is never 
given internally except in the form of the hydrate or slaked lime. 
As an escharotic application lime is used in the official caustic Potassa 
cum Calce, U. S. When given internally it should always be used 



108 DRUGS. 

as Liquor Calcis, U. S. and B. P., or lime-water, and under these 
circumstances it acts as an antacid, as an aid to the digestion of milk 
by preventing too rapid and solid coagulation of the casein, and by 
exciting an increased gastric secretion. It is also feebly astringent. 
Given to infants and nursing women, it is probably utilized in the 
body in the formation of bone. It is also of value in diabetes, in the 
uric-acid diathesis, and in the excessive nausea and vomiting very 
often seen in adults and children. Teaspoonful doses of milk and 
lime-water, equal parts, will often be retained when nothing else will 
remain in the stomach. 

The dose of lime-water is a teaspoonful (4.0) to 1 ounce or even 2 
ounces (32.0-64.0). Externally applied, lime-water is of value in 
tinea capitis and similar states, and it is the best application in burns, 
when it is to be mixed with equal parts of linseed or olive oil, form- 
ing the Linimentum Qalcis, U. S. and B. P., or carron oil. As a 
local application in membranous croup and diphtheria lime-water has 
a high reputation, and is believed to dissolve the membrane. It may 
be used as a spray or by means of a swab. 

Liquor Oalcis, or lime-water, is to be made by adding a piece of 
unslaked lime as large as a walnut to 2 quarts of boiled and filtered 
water in an earthen jar ; after stirring it thoroughly allow it to settle, 
and pour off the clear liquid into a bottle. More water may then be 
added to the lime until it is all used. 

Sulphurated lime (Calx Sulphurata, U. 8. and B. P.) is useful to 
check inflammation and hasten suppuration; the dose is ^ of a grain 
(0.006). It is of value in acne pustulosa and all forms of suppura- 
tion in the skin. Where sulphurate of lime is not obtainable and 
successive crops of boils constantly appear, it is often possible to 
relieve the patient by baking egg-shells in an oven, powdering them, 
and then letting the patient eat 1 drachm (4.0) or more of the powder 
each day. 

The preparations of the B. P. that are not official in the U. 8. 
are the saccharated solution of lime (Liquor Qalcis Saccharatus), dose 
15 to 60 minims (1.0-4.0), and slaked lime {Calcii Hydras), used in 
different preparations. 

(For Calx Chlorata see Chlorinated Lime.) 



CAMPHOR. 

Camphor (Oamphora, U. 8. and B. P.) is derived from the Oin- 
namomum Oamphora, which grows chiefly in China and Japan. The 
camphor used in the drug-stores is in reality refined camphor, and is 
so obtained by repeated sublimation. It is a volatile, irritant gum 
or resin, producing a burning taste and possessing a peculiar odor, 
soluble in 1000 parts of cold water and in 1 part of strong alcohol. 
Camphor is so volatile that if allowed to remain exposed to the air 
for any length of time it rapidly loses its bulk and eventually disap- 
pears. It is an exceedingly combustible substance, burning with a 
flame and much smoke. It may be white or pinkish in color. 



CAMPHOR. 109 

Physiological Action. — If taken in large amount, camphor pro- 
duces epileptiform convulsions, preceded by vertigo, roaring in the 
ears, and delirium. The pulse soon becomes rapid, feeble, and run- 
ning, and the skin livid, cold, and covered with sweat. Great heat 
and burning may be felt in the belly, and, if the poisoning be slow, 
evidences of gastro-intestinal and renal inflammation ensue. In small 
doses it acts as a stimulant and adds a sensation of warmth to the 
stomach, while the pulse may become more rapid and stronger under 
its influence. At the same time there is a sedation of the nervous 
system and a general feeling of contentment. In large medicinal 
dose camphor is thought by some to act as a sexual stimulant, and by 
others as a sexual sedative. The stimulant effect is probably only 
produced by doses large enough to produce irritation of the genito- 
urinary tract. The convulsions following poisonous doses are cere- 
bral in origin, and the drug, although largely destroyed in the body, 
is eliminated by the kidneys as camphoglycuric acid and escapes by 
the breath and perspiration. 

Therapeutics. — Internal Use. — Camphor is employed for the 
purpose of acting as a nervous sedative and antispasmodic in the treat- 
ment of nervous women and children, and as a carminative in persons 
who suffer from intestinal flatulence. It is of value in nervous dys- 
menorrhea and headache, and is best combined with one of the new 
analgesics, such as antipyrine and acetanilid given in pill form. As 
it is virtually a volatile oil so far as its physiological action is con- 
cerned, it will be found useful in cholera morbus and all forms of 
serous diarrhoea, but rarely in mucous diarrhoea. (See Diarrhoea ) 
In chordee, combined with bromides and similar depressants to the 
spinal cord, camphor is of great service in some cases, particularly 
late in the disease. In adynamic fevers it has been used as a diffus- 
ible stimulant by Graves and others with great success. Camphor is 
a very useful remedy in cases of sudden nervous depression. It may 
be given by the mouth or, if the emergency is a pressing one, by 
hypodermic injection. Under these circumstances it is best given in 
the form of camphorated oil in the strength of 1 part of camphor to 
9 of sweet oil, which last should be perfectly sterile. The dose of 
this solution is 15 minims (1.0), When used in the nervous depres- 
sion of phthisis, Alexander asserts that its continuous injection 
may result in cumulative action and develop the symptoms of mild 
camphor poisoning. In hiccough it is of great service, and in 
cardiac palpitation due to functional irritability it is found to be 
of value. In capillary bronchitis and catarrh of the air-passages it 
will be found useful in old or atonic cases. In chronic nasal 
catarrh spirits of camphor when inhaled from the neck of a vial 
gives off enough of the drug to start up secretion and tone up the 
parts. It is also of value as a mouth-wash in persons who have 
foetid breath. 

External Use. — Externally camphor may be used as a stimulant 
to indolent sores and as a useful addition in small amount to the pre- 
cipitated carbonate of calcium as a dusting-powder in intertrigo. In 
the form of a liniment camphor is used over inflamed joints from 



110 DRUGS. 

sprains or rheumatism, and in myalgia and neuralgia to relieve the 
pain and stiffness. 

Camphor may be inhaled or taken internally in cases of cold in 
the head with great relief and a decided influence in aborting the 
attack. After the attack is in full force it is useless, but used early 
it will decrease the frontal headache and the sneezing and running at 
the nose. In coryza from unknown causes with much lachrymation 
and incessant sneezing camphor will be found of benefit. It may be 
snuffed up the nostril in a fine powder, or powdered camphor may be 
put in boiling water and the fumes inhaled. The spirit may also be 
inhaled from a handkerchief. 

Camphorated alcohol, spirit of camphor, is a useful application for 
abortive purposes when used over boils in their formative stage, if 
repeated two or three times a day for a few moments at a time. Fol- 
lowing these applications, the skin should be dried and camphorated 
oil applied. Ringer and Tilt both recommend that eau de Cologne, 
saturated with camphor, be rubbed into the head in the drowsiness 
and headache of the menopause, and a lotion of equal parts of aqua 
ammonia and spirit of camphor dabbed on the painful or hyperses- 
thesic spots at the top of the head, so commonly felt at the change 
of life or during menstruation, will be found to give relief. 

Administration. — Camphor is used internally in the form of the 
camphor-water ( Aqua Camphors, U. S. and B. P.), dose \ to 2 fluid- 
ounces (16.-64.) ; the spirit of camphor (Spiritus CamphoroB, U. S. 
and B. P.), dose J a fluidrachm (2.0), or in the form of the camphor 
itself, in pill, in the dose of 1 to 3 grains (0.05-0.15) in each pill. 
The best preparation for internal use is the spirit, or the camphor 
itself may be given. 

For external use we have, official, the camphor liniment (Lini- 
mentum Camphor w, U. S. and B. P.) and the soap liniment, or Lini- 
mentum Saponis, U. S. and B. P., which is the mildest of the two. 
Ceratum Camphorai is also official. A compound tincture of camphor 
(Tinctura Camphorce Composita), composed of opium, benzoic acid, 
camphor, and oil of anise, is official in the B. P., dose 15 minims to 
1 fluidrachm (1.0-4.0). Linimentum Camphor 02 Composition, B. P., 
is composed of camphor, rectified spirit, and stronger ammonia. 



CAMPHOR MONOBROMATB. 

Monobromated Camphor {Camphor a Monobromata, U. S.) is made 
by heating together in a sealed tube camphor and bromine. It occurs 
in colorless crystals or scales, and has a mild taste resembling camphor. 
It is almost entirely insoluble in water, but freely soluble in alcohol, 
ether, and chloroform. 

Physiological Action. — Monobromated camphor possesses powers 
partaking of the bromides and of camphor. In the frog it causes loss 
of reflex action, motor palsy and death by respiratory failure, and in 
warm-blooded animals violent convulsions, Cheyne-Stokes respirations, 
muscular tremblings, and weakness. The pulse is at first more rapid 



CANNABIS INDICA. Ill 

than normal, then slow and weak, death coming in coma or during 
the convulsions. 

Therapeutics. — Monobromated camphor will generally be found most 
useful for pain when combined with other drugs, particularly in lum- 
bago, or the pain due to nervous disturbances. If used in hysterical 
females, it will often produce sleep, and is of value to those who are 
addicted to the camphor-habit, as it acts as a hypnotic and warms 
the stomach. Like camphor itself, it is a gastric irritant, and 
should not be employed where gastritis exists. It has been used in 
spermatorrhoea with great success, and in delirium tremens has been 
found of benefit in cases where the gastric mucous membrane is 
depressed and the nervous twitchings are troublesome. In whooping 
cough it may be tried, and it has even been used in chorea, epilepsy, and 
petit mal. In the nervous depression and pains of epidemic influenza 
monobromated camphor has been largely used. (See Acetanilid.) 

Administration. — It should never be used hypodermically, as it is 
too irritating, but administered in the dose of 5 grains (0.35) three 
times a day in pill, or in an emulsion made by dissolving it in six 
times its weight of expressed oil of almonds and then forming an 
emulsion with gum arabic and water in the usual manner. 

CAMPHORIC ACID. 

Camphoric Acid is made by the oxidation of camphor through the 
influence of acids, and has been used in the night-sweats of phthisis 
with great success. In a large number of cases suffering from night- 
sweats the author has found this drug to act very favorably indeed 
where other remedies failed. 

It may be resorted to in the dose of from 20 to 30 grains (1.3-2.0), 
taken an hour or two before the sweat is expected. In very obstinate 
cases as much as 60 grains (4.0) should be given, but under these cir- 
cumstances it should be used in two separate doses of 30 grains (2.0) 
each, two hours apart, in order to avoid irritating the stomach. It is 
best given in capsule, as it is insoluble in water. In other instances 
camphoric acid may be given in the following formula : 

R. — Acid, camphoric ^iv (16.0). 

Alcohol f^ij (64.0). 

Mucilag. acaciae f.liij (96.0). 

Syr. aurantii corticis q. s. ad f Jvj (128.0). — M. 

S. — Dessertspoonful (8.0) to a tablespoonful (16.0) one hour before sweat is expected. 

It is worthy of note that camphoric acid is possessed of little power, 
in the writer's experience, in cases of bromidrosis. 

CANNABIS INDICA. 

Indian Hemp (Cannabis Indica, U. S. and B. P.) is the flowering 
tops of the female plant of Cannabis Sativa. It is to be distinctly 
separated from the so-called American, American-Indian, or Canada 
hemp, or Apocynum Cannabinum, which is an intense irritant and 
drastic. 



112 DRUGS. 

Physiological Action. — Given in full dose to man, this drug causes 
exhilaration and periods of constant laughter arising from the slightest 
cause, the person seeming convulsed with merriment ; in other cases 
the sensations are disagreeable, and even death may seem imminent to 
the deranged mind. Often the sensation of very full breathing comes 
on, and the patient thinks he is about to burst with the inflation of 
his lungs. After this deep sleep appears, lasting for many hours, 
even as much as fourteen or fifteen, without any intervals of wake- 
fulness. If the dose be very large, the respirations are slowed very 
considerably, but no death from the use of cannabis indica by man is 
on record, and enormous amounts have been given to the lower ani- 
mals without causing a lethal effect. 1 Applied to mucous membrane, 
it acts as a very severe irritant, and then as a local anaesthetic, but 
the primary effect is so powerful as to prevent its local use to mucous 
membranes for the relief of pain. 

One of the most constant and pressing symptoms in poisoning in 
man is the marked sensation of prolongation of time, so that minutes 
seem like hours, and, in addition to this, a peculiar separation of the 
mental powers occurs, during which both hemispheres of the brain 
seem to think differently on the same subject. 

Therapeutics. — Cannabis indica is one of the best additions to 
cough mixtures that we possess, as it quiets the tickling in the throat, 
and yet does not constipate or depress the system as does morphine. 
In advanced phthisis it is justifiable to constantly keep the patient in 
the state of euthanasia by its use. For the relief of pain, particularly 
that depending on nerve disturbance, it is very valuable. Before the 
introduction of antipyrine and its congeners tincture of gelsemium 
and the tincture or extract of cannabis indica were our best remedies 
in migraine. The gelsemium under such circumstances should be 
given in full dose, 20 drops (1.3) of the tincture, and be followed by 
10 to 20 drops (0.65-1.3) of the fluid extract of cannabis indica, it 
being known that the sample about to be used is active. After this 
dose of gelsemium the patient should be carefully watched, lest he 
suffer from an excessive influence of the drug, as such an amount 
may produce great depression in susceptible persons. In true migraine 
with hemianopsia this treatment is often most effectual in aborting 
the attack. The prevention of further attacks is to be attained by 
the use of smaller amounts of the cannabis indica during the inter- 
vals, the gelsemium only being used at the onset of the symptoms. In 
paralysis agitans cannabis indica may be used to quiet the tremors, 
and in spasm of the bladder, due to cystitis or nervousness, it often 
gives great relief. In sexual impotence, not dependent upon organic 
disease, it is said to be of value combined with strychnine or nux 
vomica and ergot. When a patient suffers from sleeplessness which 
is due in part to pain and in part to nervousness, the following pre- 
scription may be given : 

1 The author has injected as much as 5 drachms of a fluid extract, active in the 
dose of 10 minims to man, into the jugular vein of a small dog without producing 
death for man} 7 hours. 



CANNABIS INDICA. 113 

SodUbromidi} aa 3J (4.0). 

Ext. belladonna fl ffy (4.0). 

Ext. cannabis indicae fl fgj (4.0). 

vSyr. acaciae f^vj (192.0).— M. 

S. — Tablespoonful (16.0), in water, at a dose at night, to be repeated once. 

In headaches at the menopause cannabis indica is useful, and if the 
headaches are associated with constipation and anaemia, iron and aloes 
should be given simultaneously. Where headaches are due to retinal 
asthenopia a very useful prescription, according to de Schweinitz, is 
as follows : 

R. — Tr. nucis vomicae f^ij (8.0). 

Tr. cannabis indicae fjij (8.0). — M. 

S. — 15 drops (1.0), in water, twice or thrice a day. 

The following prescription has been found to be very efficient in the 
hands of the author in treating gastralgia and similar forms of pain : 

R.— Tr. capsici f^ij (8.0). 

Tr. cannabis ind. f.^ss (16.0). 

Tr. opii deodoratae f^j (32.0). 

Spt. chloroformi fjj (32.0). 

Spt.lavendul.comp q. s. ad fjiv (128.0).— M. 

S. — Teaspoonful (4.0) every hour until pain is relieved. 

In uterine subinvolution, chronic inflammation and irritation can- 
nabis indica is of great value, and it has been found of service in 
metrorrhagia and nervous and spasmodic dysmenorrhoea. Not only 
does it relieve the pain, but it seems to act favorably upon the mus- 
cular fibres of the uterus. 

In acute and chronic Bright* s disease cannabis indica often allays 
the painful sensations over the renal region, and has been recom- 
mended by some writers in the cases in which bloody urine is present. 
In gonorrhoea it is said to decrease the discharge and prevent chordee, 
and it has supplanted the use of copaiba and cubebs in some practi- 
tioners' hands. It should not be used in the early stages of gonor- 
rhoea, but in the later or subacute stages. 

There is some foundation for the belief that in small doses it acts 
as a sexual stimulant. The advantages possessed by it are that it does 
not constipate, nor does it cause after-depression and nausea. On the 
contrary, there is often an increase rather than a decrease of the appe- 
tite under its influence. In the Anglo-Saxon race the cannabis-indica 
habit is practically unknown, but in the East Indies when used to 
excess it sometimes causes maniacal insanity, from which the patient 
nearly always recovers after some days, weeks, or months. 

Administration. — The employment of this most valuable remedy is 
handicapped by its frequent lack of power — a fault which is largely 
dependent upon its preparation. The drug as prepared by Parke, 
Davis & Co. has proved efficacious in the author's hands for a number 
of years. The physician should always employ some preparation 
known by him to be active by personal trial before condemning the 
drug as a failure in a given case. 

The dose of the solid extract (Extr actum Cannabis Indicoe, U. S. 
andi?. P.) is from \ to \ grain (0.015-0.03), that of the fluid extract 



s 



114 DRUGS. 

(Extractum Cannabis Indicce Fluidum, U. S.) from 4 to 20 minims 
(0.3-1.3), and that of the tincture (Tinctura Cannabis Indicce, U. S. 
and B. P.) from 15 minims to 1 drachm (1.0-4.0). 



CANTHARIS. 

Cantharis (U. S. and B. P.), or " Spanish Fly," is really a beetle, 
known as the Cantharis vesicatoria, and as such appears with irides- 
cent coverings or wing-sheaths of a bluish or greenish hue. The 
insects come chiefly from Spain, Italy, and Sicily, and from the south- 
ern parts of Russia. Those from Russia are supposed to be the best. 
According to Leidy, the vesicating substance is in the blood, the eggs, 
and the secretions of the generative apparatus. The blistering sub- 
stance contains cantharidin as an active principle, but cantharidin is 
not medicinally employed. 

Physiological Action. — The ingestion of a moderate dose of can- 
tharides produces only slight stimulation of the geni to-urinary system, 
particularly the kidneys and urinary tracts. Large amounts produce 
great pain in the lumbar region, burning in the bladder and entire 
urethra, priapism, agonizing vesical tenesmus, widespread acute 
nephritis, bloody urine, which is scanty at first, and finally sup- 
pressed, with great irritation of the external openings of the genito- 
urinary apparatus. The inflammatory changes which are produced 
may cause sloughing of the penis or of the labia in the female. 

Violent gastro-enteritis is nearly ahvays a pressing condition. A 
diagnostic sign of cantharidal poisoning, where the beetles have been 
swallowed, is the appearance of pieces of the iridescent wings and coats 
in the vomit. Thirst is ahvays a prominent symptom of poisoning by 
cantharides. 

Therapeutics. — Cantharides are employed internally and externally. 
When given by the mouth the tincture is used as a uterine stimulant, 
to aifect the uterine mucous membrane and relieve amenorrhea in 
cases where atony and depression are the cause of the suppression. 
Some persons teach that the tincture of cantharides is a valuable 
remedy in small doses in the second stage of acute desquamative 
nephritis, but in the instances where the writer has seen it used it 
has made matters much worse, although it is supposed to decrease the 
quantity of the albumin and blood. In the later stages, where the kid- 
neys are relaxed and torpid or where albuminuria comes on on the 
slightest exertion, cantharides in the dose of 1 drop (0.05) of the tinc- 
ture three times a day are of great service. 

In cases of chronic nephritis, particularly where alcoholism is the 
cause of the disease and the kidneys are inactive, cantharidal tincture 
is very useful. In pyelitis and in chroiiic cystitis it is of service, and 
it has been recommended very highly in drop doses in irritability of 
the bladder in women and children. In these cases the bladder must 
not be inflamed, but irritable from depression. The use of canthar- 
ides is of value in incontinence of urine of a minor degree, as that 
occurring in some elderly or nervous females when coughing, sneez- 



CAPSICUM. 115 

nig, or laughing, and will often give relief after many years of 
suffering. In chordee, in the dose of 1 drop (0.05) twice or thrice 
daily, it is of service. For impotence depending upon sexual excess 
Ringer asserts that the use of 10 to 15 drops (0.65-1.0) of the tinc- 
ture of cantharides, with full doses of the tincture of the chloride of 
iron and nux vomica, will often relieve the patient and enable him to 
beget children. The drug has no true aphrodisiac influence except 
in toxic dose. In gleet of a very chronic type and in prostatorrhoea 
it is of service. Dermatologists have used cantharides internally as 
a remedy in psoriasis, eczema, lichen, and prurigo, with asserted great 
success. The dose should be so small as not to irritate the stomach. 

The unofficial plasters of cantharides made by several firms are 
the best preparations to use for the production of a blister. In order 
to obtain a perfect effect the skin should be washed thoroughly with 
soap and water and dried with a towel, which should be rough enough 
to produce reddening of the cuticle. After this wet the skin with 
vinegar, and while wet apply the blister. 

Externally, cantharides are used in the production of vesication 
for the purpose of withdrawing water from a small area or as a coun- 
ter-irritant of some severity in cases of deep-seated inflammations. 
(See Counter-irritation.) Care should be taken that a sufficient 
amount of the drug is not absorbed to cause strangury and renal 
irritation. In renal congestions and inflammations the use of can- 
tharides as a counter-irritant is often contraindicated for this reason. 
In the proportion of 1 drop (0.05) of the tincture of cantharides to 
40 (2.65) of water it is said to be a very good application for burns, 
but how it acts is not known. 

Administration. — The dose of the tincture (Tinctura Cantharidis, 
U. S. and B. P.) is from 1 to 10 drops (0.05-0.65), and it is the only 
preparation used internally. The cerate (Ceratum Cantharidis, U. S.) 
is used, spread upon a rag, to produce a blister, and the cerate of the 
extract, which is no longer official, is used for the same purposes and 
in the same manner. The cantharidal collodion (Collodium Canthari- 
datum, U. S.) is a method of applying the blister which is most 
cleanly, but there is more danger of absorption of the irritant if it is 
used. The collodion acts as a protective to the part. The papers of 
cantharides {Charta Cantharidis, B. P.) are used as blisters, but are 
weak in action. The liniment of cantharides (Linimentum Canthari- 
dis, Liquor JEpispasticus, B. P.) is employed as a counter-irritant. 

"Warming plaster" {Emplastrum Picis Cantharidatum, U. S.) is 
a mild counter-irritant to be employed where a blister is thought to 
be too severe. The preparations of the B- P., other than those 
named, are Acetum Cantharidis, Qharta Epispastica, Emplastrum 
Qalefaciens, Emplastrum Cantharidis, and Unguentum Cantharidis. 



CAPSICUM. 

Capsicum, U. S., Capsici Fructus, B. P., or Cayenne Pepper, is 
the fruit of Capsicum Fastigiatum, a native of tropical Africa and 



116 DRUGS. 

of Central America. It occurs in long ovoid pods, which, when ripe, 
are scarlet red and possess a very hot, burning taste. The active 
principle is capsicin, which is a dark reddish liquid, or, in other 
words, is a volatile alkaloid. 

Physiological Action. — Locally applied to the skin or mucous 
membranes, capsicum causes great redness, and finally, in the case 
of mucous membranes, vesication. The alkaloid will also produce 
these changes in the skin. When used internally for any length of 
time in excess capsicum will cause a chronic or subacute gastritis 
with pain and discomfort over the liver and stomach. If single large 
doses are used renal irritation and inflammation ensue, with strangury 
and high-colored urine. Taken internally, capsicum is said to act as 
a circulatory stimulant. 

Therapeutics. — In cases of atony of the stomach due to general 
debility, errors in diet, and alcoholism of the chronic type capsicum 
is one of the best remedies we have. In cases of acute alcoholism the 
gastric mucous membrane is often too much irritated to permit of its 
use, but after the lapse of some days it may be found of benefit to 
increase the appetite. As a remedy for subacute alcoholism it is 
quite useful, since by its stimulating effect and hot sensation it often 
satisfies, at least to some degree, the craving for liquor. Under these 
circumstances it should be used in the dose of 5 to 10 drops (0.3- 
0.65) of the tincture every four or five hours, or as the oleoresin in 
pill in the dose of J to 1 grain (0.03-0.05). The following prescrip- 
tion has been found of great service in the wards under the writer's 
charge at St. Agnes's Hospital in these cases : 

R.— Tr. capsici f ^ijss (10.0). 

Tr. opii deodorat f gij (8.0). 

Spt. aether, nitrosi f^iv (16.0). 

Spt. lavandulse comp q. s. ad f 3iv (128.0). — M. 

S. — Dessertspoonful (8.0) every four or five hours. 

In the flatulent colic of old persons and young adults capsicum 
will be found not only to act as a carminative, but also to prevent the 
development of the gas. In low fevers it has been used as a diffusible 
stimulant, but it is of doubtful value. It is rather in the anorexia 
of convalescence that capsicum acts most favorably. In chronic 
nephritis it is of considerable service, and it tends to check albumi- 
nuria, but it is only to be used in the chronic forms and stages of 
renal disease or in the treatment of functional torpidity of the kid- 
ney. The tincture is to be given under these circumstances in the 
dose of 20 drops (1.3) or less, but in some cases which are very 
chronic, as much as 40 drops (2.65) may be used. In sore throat and 
simple tofisillitis the tincture of capsicum and glycerin, half and half, 
are very useful as a local application applied by means of a swab. 
The same preparation may be used as a gargle for relaxed uvula and 
sore throat. Applied externally, capsicum acts as a counter-irritant, 
producing redness of the skin, but not a blister in the ordinary indi- 
vidual. It is one of the best moderate counter-irritants which can 
be used, and it may be employed by saturating blotting-paper, time 



CARBOLIC ACID. 117 

and time again, in the tincture of capsicum, allowing it to dry 
between each dip. This paper should finally be placed when warm 
and wet over the part, and held closely to the skin by a compress. 
Capsicum plaster (Emplastrum Capsici, U. S.) is useful in lumbago, 
rheumatism, and in headache when applied to the nape of the neck. 
The tincture is sometimes painted over chilblains which are unbroken. 
The following method, given by Ringer from Rheims, is very effica- 
cious in this annoying affection : 

"Make a strong tincture of capsicum-pods by steeping them for 
several days in a warm place in twice their weight of rectified spirits 
of wine. Dissolve gum arabic in water to about the consistence of 
treacle. Add to this an equal quantity of the tincture, stirring 
together with a small brush or a large camel's-hair pencil until they 
are well incorporated. The mixture w r ill be cloudy and opaque. 
Take sheets of silk or tissue-paper ; give them, with the brush, a coat 
of the mixture ; let them dry, and then give another. Let that dry, 
and if the surface is shining, there is enough of the peppered gum ; 
if not, give a third coat. This paper should be applied in the same 
way as court-plaster to chilblains that are not broken and burns that 
are not blistered, and it will speedily relieve the itching and pain. 
It acts like a charm and effects a rapid cure. The same is true of 
discolored bruises. It likewise allays rheumatic pains in the joints." 
The dose of capsicum is 1 to 2 grains (0,05-0.1) in pow r der, on 
food or in pill. The dose of the tincture of capsicum (Tinctura Cap- 
sici, U. S. and B. P.) is 10 to 30 drops (0.65-2.0), and of the oleo- 
resin {Oleoresina Capsici, U. S.) J to \ grain (0.015-0.03). The 
dose of the fluid extract (Extractum Capsici Flmdum, TJ. S.) is 1 to 
3 minims (0.05-0.15). The plaster (Empla&trum Capsici) is useful 
for external applications. 



CARBOLIC ACID. 

Carbolic Acid (Acidum Carbolicum, TJ. S. and B. P.) is also 
known as Phenol, Phenylic Alcohol, and Phenic Acid. Not only is 
it an acid, but in addition it is an alcohol of the peculiar group 
known as the phenols, which are derived from coal-tar by a process 
of distillation. 

Carbolic acid is sold in several grades, No. 1 being the purest. 
Both Nos. 1 and 2 are crystalline, while Nos. 3, 4, and 5 are impure, 
because of cresylic acid and other foreign substances. Only No. 1 
should be used by the mouth. 

It has a peculiar characteristic odor, and varies in color according 
to its method of preparation and purity. It is soluble in 20 per cent, 
of water, but it is liquefied by the addition of 6 per cent, of water. 
Carbolic acid should be kept in dark amber-colored, well-stoppered 
bottles. 

If the crystals be exposed to the air, they undergo liquefaction, 
and in consequence the purest carbolic acid is usually prescribed in 
drop doses rather than in grains, It is soluble in alcohol, ether, chlo- 



118 DRUGS. 

roform, glycerin, and most oils. It unites with alkaline bases to form 
salts, carbolates, but these are very readily decomposed by the feeblest 
acids, such as carbonic acid. 

Physiological Action. — Locally applied, carbolic acid produces at 
first a burning over the skin, accompanied by a diffuse reddening of 
the surface. If the solution be very strong, the part at once becomes 
temporarily painful, then bleached and numb, so that tactile sensibil- 
ity is destroyed. Applied to mucous membranes, it causes similar 
changes, but to a more marked degree, and may even act as a mod- 
erately severe caustic of a superficial type. Owing to the local coag- 
ulation of albumin produced by it, it cannot penetrate very deeply. 

Nervous System. — Carbolic acid acts as a depressant and para- 
lyzant to the peripheral sensory nerves when locally applied. Upon 
the higher centres in the brain the acid produces a condition of 
depression and stupor. 

The convulsions which sometimes occur after toxic doses are spinal 
in origin, as they occur after section of the spinal cord. The motor 
nerves escape almost untouched, as do also the muscles. 

Circulation. — Upon the circulation in the higher animals the 
drug exercises a distinct depressant influence, stopping the heart 
in diastole in lethal dose and paralyzing the vasomotor centre even 
before the cardiac muscle is affected. These changes follow only 
lethal doses. Small medicinal doses have no effect of any moment 
upon the circulation. 

Respiration. — After large doses the breathing becomes more 
rapid and full. These changes, according to Salkowski and others, 
are due to stimulation of the respiratory centres and the peripheral 
vagi. Lethal doses almost invariably kill by failure of respiration 
due to depression of the centres. 

Temperature. — Carbolic acid acts as a depressant to normal bod- 
ily temperature even in medicinal dose, and also decreases the bodily 
heat in fever. It lowers fever by diminishing heat-production and 
increasing heat-dissipation. This antipyretic power is hardly suf- 
ficient to permit of its use in disease. 

Kidneys and Elimination. — When carbolic acid is given in 
overdose the kidneys may become so irritated that total urinary sup- 
pression may occur. When taken in large quantity it causes the 
urine to become brownish-black. This discoloration is due to an oxi- 
dized educt of carbolic acid which is not yet isolated. The drug is 
eliminated as a sulpho-carbolate of sodium and potassium and as 
glyco-uronic acid and hydrochinon. Part of the carbolic acid is 
burnt up in the body. 

It is to be distinctly understood that the dark urine of carbolic- 
acid poisoning is not due to the presence of blood or any of its 
educts. 

Poisoning, Prolonged and Acute. — As the changes produced in the 
tissues of the body by acute and chronic poisoning by carbolic acid 
are identical, they may be considered together. 

Carbolic acid is one of the most rapidly-acting poisons known, 
notwithstanding the fact that few people seem to recognize it as such. 



CARBOLIC ACID. 119 

If a large lethal dose be swallowed by a man, he may drop dead from 
its effects before he can go more than a few feet from the spot where 
he stood when drinking it, or he may live a few hours. In cases 
where death has occurred suddenly from the acid the cause has been 
failure of respiration. If the patient does not die at once, all the evi- 
dences of gastro-enteritis come on. Violent vomiting and purging 
may ensue, and burning pain in the entire abdomen is a prominent 
symptom. The skin is wet with sweat, the face pinched and anxious. 
Collapse, with a thready, imperceptible pulse and extreme dyspnoea, 
may be present. The mouth and lips may not smell of the drug, but 
the mucous membrane will be seen to be corrugated and stained black 
if impure acid has been taken, or be whitish if the pure drug has been 
used. The eschar on the mucous membrane is a peculiar one, and is 
pathognomonic of the poison, having a white centre surrounded by a 
reddened and inflamed zone, the centre sometimes becoming dark brown 
or black. The post-mortem will show these spots in the oesophagus 
and stomach, and even in the intestines. All the internal organs, as 
the brain, kidneys, liver, and spleen, will be found filled with dark 
grumous blood, and on opening the body the strong odor of the acid 
will be perceived. A peculiar croupous exudate is sometimes found 
in the bronchial tubes, and fatty degeneration of a more or less wide- 
spread type often follows carbolic-acid poisoning. Langerhaus has 
noted that in some of these cases evidences of croupous pneumonia 
exist. A very common symptom is hoarseness of the voice, due to 
an effect on the larynx after the drug is absorbed, and not from its 
local influence. 

A large number of cases are on record in which carbolic-acid poi- 
soning has been produced by its absorption from surgical dressings. 
One of the earliest signs of such an accident is a darkened, smoky 
urine and a slight nervous unrest or cerebral disturbance. Very often 
pain in the lumbar region indicates kidney strain and irritation. 
The dressings should be, of course, at once removed. 

TreaTxAient of Poisoning. — The chemical antidote to carbolic 
acid is any soluble sulphate, such as Epsom or Glauber salts, which 
forms insoluble sulpho-carbolates. As these salts follow the acid into 
the blood-vessels and tissues to unite with it, the mere fact that hours 
have elapsed since the poison has been taken does not invalidate the 
propriety of using these sulphates. The further treatment consists 
in the administration of warm mucilaginous drinks, hot applications 
to the extremities, the ingestion of cardiac and respiratory stimu- 
lants, such as digitalis and strychnine, opium to relieve pain, and 
counter-irritation over the abdomen. Emetics and the stomach-pump 
should be used if possible, but the former are generally useless 
because of the state of the stomach. 

Therapeutics. — Internally carbolic acid is little used, but, never- 
theless, has a very favorable effect in certain states. In nervous vom- 
iting or in that due to gastric irritation the drug does good in J- to 
2-drop (0.03-0.10) doses by depressing the sensory nerves in the 
stomach. 

In diarrhoea depending upon fermentation from 2 to 4 drops (0.10- 



120 DRUGS. 

0.20) of the acid do great good, particularly if combined with 10 to 
20 grains (0.65-1.3) of bismuth administered in powder or capsule. 

In gangrene and tuberculosis of the lung a spray of the acid in 
water in the strength of 5 to 15 drops (0.3-1.0) to the ounce (32.0) 
may do some good, and at least stop the cough and relieve the irrita- 
tion and tickling in the throat. 1 Creasote is, however, generally pre- 
ferred in these conditions at the present time. 

Externally the acid is very largely employed as an antiseptic 
lotion, and in solutions in which to place instruments while operating. 
The solutions for this purpose should be in the proportion of 1 of 
acid to 20 of water. (See Antiseptics.) 

Carbolic acid is rarely used directly over wounds in dressings at 
present unless the dressing be one of carbolized oil. Other drugs 
have supplanted it. The use of the carbolized spray over wounds 
has been found to do more harm than good, and it ought never to be 
employed. 

In diphtheria, ulcerated sore throat, and even in ordinary stomatitis, 
carbolic acid will be found of value when used in a spray or mouth- 
wash in the proportion of 1 part to 75 parts of water, and in ordi- 
nary sore throat in the strength of 1 part to 100 of water it will be 
found, when applied on a swab or by a gargle, to relieve the pain and 
inflammation. In the treatment of burns carbolized sweet oil in the 
proportion of 1 drachm (4.0) of the acid to each 6 ounces (192.0) 
makes one of the best dressings that can be used. By means of the 
local anaesthesia produced by the acid, minor operations, such as ever- 
sion of the toe-nail or opening a felon, may be performed by soaking 
the part for ten minutes in a solution of 30 parts to 100, and apply- 
ing the pure acid by means of a brush to the line of the incision. 
Carbolic acid may be used as a lotion in the itching of jaundice in the 
proportion of 10 grains (0.65) of the acid to 2 drachms (8.0) of gly- 
cerin and 2 drachms (8.0) of water. In enlarged glands which have 
not yet gone on to suppuration intra-glandular injections with a hypo- 
dermic needle are of value in a large number of cases, the solution 
used being no weaker or stronger than 2 per cent. ; 5 to 10 minims 
(0.3-0.15) of this solution is sufficient for each gland. In the treat- 
ment of buboes 10 minims (0.65) of a solution of 8 grains (0.5) to the 
ounce (32.0) may be injected into the swelling, the skin being first be- 
numbed by an ether spray. This is a most successful treatment. The 
same treatment may be applied in chronic synovitis and repeated every 
three days, and boils and carbuncles may also be so treated with great 
success if the measure be used early enough to abort the trouble. 

In the form of an ointment carbolic acid may be used in the 
strength of 10 minims to the ounce (0.65 : 32.0) of simple cerate, par- 
ticularly in cases of subacute eczema where there is a great amount 
of weeping and itching. 

As a disinfectant carbolic acid ranks among the poorest : 1 to 2 
per cent, solutions, however, kill most spores and germs. 

Administration. — Carbolic-acid ointment {JJnguentum Acidi Car- 

1 The spray must be a very fine one, or it will not carry the drug far enough down 
into the lungs to do any good. 



CARBON. 121 

bolici, U. S. and B. P.) and the glycerite (Grlgcerita Acidi Carbolici, 
U. S.) are the only official preparations of carbolic acid in the 
U. S. P. In the B. P. the following preparations are official : Acidum 
Carbolicum Liquef actum, given in the dose of 1 to 2 minims (0.05- 
0.10); Grlyceritum Acidi Carbolici; and Suppositoria Acidi Carbolici 
cum Sapone, each suppository containing 1 grain (0.05) of carbolic 
acid. 

CARBON (CHARCOAL). 

Carbo Ligni, U. S. and B. P., or Charcoal, is prepared by the 
exposure of soft wood to a red heat, air being prevented from coming 
in contact with the wood during the process. Charcoal when used 
for medicinal purposes should be a black, brittle, somewhat shiny, 
porous substance, devoid of taste and odor, and completely insoluble 
in water. Owing to its power of absorbing a very large amount of 
certain gases, it is of value in medicine in states where these gases 
abound. 

Therapeutics. — Charcoal is used externally as an application to old 
sores or sloughs to act as a deodorant and antiseptic. This is accom- 
plished by the absorption of any liquids which may be present, 
thereby depriving germs of a nidus, and by its distinct oxidizing 
power. It may be applied in the form of a dry powder or in a poul- 
tice, which is, however, so uncleanly that other antiseptic dressings 
are better. 

The poultice (Cataplasma Carbonis, B. P.), if used, should be 
made in the following manner : Take of powdered wood-charcoal J 
ounce (16.0), bread-crumbs 2 ounces (64.0), linseed meal 1J ounces 
(48.0), and add boiling water 10 fluidounces (320.0). Macerate the 
bread-crumbs and meal for ten minutes over the fire, and then stir 
in the charcoal to the extent of half the amount just named. Spread 
out the poultice and sprinkle the remaining half of the charcoal over 
its surface, and apply to the part affected while hot. 

Internally, charcoal is used in powder in many conditions, and 
acts very well indeed in cases of so-called " sour stomach" from 
which eructations of gas or sour liquids take place. 

The following prescription will also be found useful in the atonic 
or subacute gastric catarrh of persons who are careless in eating and 
who have much belching : 

R. — Oleoresin. capsici gtt. x vel xx (0.65-1.3). 

Pancreatin gr. xx (1.3). 

Pulv. zingiberis gr. xl (2.65). 

Pulv. carbon, ligni gr. xl (2.65). — M. 

Ft. in pil. No. xx. 
S. — One or two t. d. 

As ordinary charcoal is not always obtainable, it may be substi- 
tuted by pieces of very thin toast burnt to a state of charcoal through 
and through. A few of these pieces will, when eaten, often stop all 
the symptoms mentioned. If the attack is very severe and vomiting 
eventually ensues, the ejecta will commonly be found to be odorless 
and not sour, and the stools w T ill also be almost odorless, though 



122 DRUGS. 

black. In fermentative and acid diarrhoeas in children and adults 
this method of treatment is often of value. When charcoal is used 
in any condition associated with irritation of the mucous membranes 
of the gastro-intestinal tract, it should always be very finely pul- 
verized. 

As a filter for impure water, charcoal, in mass or in powder, is one 
of the most satisfactory substances we have. 

CARBON DISULPHIDE. 

Carbonei Disulphidum, U. S., is a clear, colorless, highly refrac- 
tive liquid, having a strong characteristic odor, a sharp aromatic 
taste, and a neutral reaction. It should be kept in well-stoppered 
bottles remote from light or fire. 

Poisoning. — The symptoms of poisoning by disulphide of carbon 
consist in headache and nervous excitement resembling in many 
respects the symptoms of belladonna poisoning, particularly in the 
volubility of the patient and the evidences of hysterical tendencies. 

Prolonged exposure to the fumes of this drug causes great cachexia 
and pallor, accompanied by muscular weakness and failure of intel- 
lectual power. Sometimes convulsions of an epileptiform character 
come on. In other cases amblyopia is present as the result of expo- 
sure to its vapor. 

The treatment of poisoning by disulphide of carbon consists in 
quieting the nervous system, if convulsive disorders are present, by 
the use of bromide of potassium and chloral, and in supporting the 
circulatory system if any evidences of its failure manifest themselves. 
Circulatory depression is not, however, a common condition except 
in very advanced poisoning. 

Therapeutics. — Disulphide of carbon has been used in medicine 
externally over enlarged lymphatic glands. The application is made 
by placing the liquid in a bottle of such a size that the mouth of the 
vessel is large enough to cover the diseased area. In the bottle 
should be placed a sponge large enough to contain a fluidrachm (4.0) 
of the drug, and the skin over the gland should be well moistened 
with water. The vapor derived from the drug under these circum- 
stances is an active agent in promoting a cure. Disulphide of carbon 
has also been used in a similar manner in the treatment of neuralgia. 



CARBONATE OP POTASSIUM. 

Carbonate of Potassium (Potassii Carbonas, U. S. and B. P.). 
This salt is never used in medicine, except to prepare other salts, as 
it is disagreeable to the taste and is an irritant. (See Potassium 
Citrate.) 

CARBONATE OP ZINC. 

Precipitated Carbonate of Zinc {Zinci Carbonas Prwcipitatus, U. S. ; 
Zinci Carbonas, B. P.) is used as a protective, rather astringent pow- 



CASCARA SAGRADA. 123 

der over surfaces covered by weeping eczema and similar moist dis- 
charges. It may be employed to fulfil all the indications commonly 
treated by the oxide of zinc. It is very largely used, not as the pre- 
cipitated carbonate, but as the impure or native carbonate, under the 
name of calamine. 

The following prescription is useful for moist eczema : 

R — Calamine • . . £j (4.0). 

Ung. zinci oxidi 3vij (28.0).— M. 

S. — Apply to the eczematous spot. 

In cases of infantile intertrigo or redness of the buttocks and gen- 
itals from maceration due to diarrhoea or urination the following lotion 
is very useful indeed : 

R.-Pulv. calamine \ aa ^ij (8.0). 

Pulv. zmci oxidi / o j \ j 

Glycerini £iv (16.0). 

Alcoholis f|ij (64.0) 

Aquse q. s. ad Oj (J litre). — M. 

S. — Apply after each removal of the diaper. 



CARDAMOM. 

Cardamom (Cardamomum, U. S.) is the fruit of Elettaria Repens, 
and is a bitter tonic possessing some aromatic properties. It is use- 
ful in cases of atony of the stomach and small intestine, particularly 
if combined with some other bitter, such as gentian, and a mineral 
acid. Cardamon is official in the B. P. as Cardamomi Semina. 

If the intestine is atonic and secretion is deficient, the following 
prescription will be found of value : 

R .—Acid, nitric, dil f gj (4.0). 

Tr. cardamomi comp. . . . . q. s. ad f^vj (192.0). 
S. — Dessertspoonful (8.0) after each meal. 1 

Administration. — The official preparations of cardamoms are the 
tincture of cardamoms (Tinctura Cardamomi, U. S.), dose 1 to 3 
drachms (4.0-12.0) ; and the compound tincture {Tinctura Cardamomi 
Composita, TJ. S. and B. P.), which is to be given in the same dose 
as the tincture. This tincture also contains cochineal, cinnamon, 
caraway, and glycerin. Cardamom is also a constituent of the 
official aromatic powder (Pulvis Aromaticus, U. S.). 



CASCARA SAGRADA. 

Cascara Sagrada is the bark of the Rhamnus Purshiana, U. S., a 
plant growing in California. It is sometimes called California buck- 
thorn, to distinguish it from ordinary buckthorn or Rhamnus Fran- 
gula, which it closely resembles in many ways, and which may be 
used as a substitute for cascara sagrada in some cases. 

1 While the rule that an acid is incompatible with a tincture is not recognized in 
this mixture, the quantities of acid and alcohol are so disproportionate that ether in 
any amount is not developed. 



124 DRUGS. 

Therapeutics. — Cascara sagrada ought never to be used as a purge, 
but only as a laxative. It is by far the best remedy we have when 
employed simply to empty the bowel of faecal matter in cases of con- 
stipation, since it not only performs this function without intestinal 
disturbance, but simultaneously acts as a tonic to the intestine, and 
so prevents the constipation which usually follows the use of all other 
drugs of its class. 

Cascara sagrada is most commonly employed in this country in the 
form of the fluid extract (Extractum Rhamni Purshiance Fluidum, 
JJ. S., or Extr actum Cascara? Sagradce Liquidum, B. P.), in the dose 
of from 10 to 20 drops (0.65-1.3) at night or morning and night. 
If 20 drops (1.3) fail to act, 30 drops (2.0) may be used, but if larger 
doses are required other drugs should be employed, as fluidrachm doses 
have been known to produce irritation of the bowel, with enteritis or 
intestinal catarrh. The objection to cascara sagrada is its bitter taste, 
which may be partially overcome by the additional use of the Syrupus 
Aurantii, in the proportion of 1 part of the cascara extract to 2 parts 
of the syrup of orange-peel. 

Some of the preparations of this drug are now made in an almost 
tasteless form, such as " Cascara Cordial," or the non-bitter fluid 
extract made by a prominent firm in this country. The solid extract 
(Extr actum Cascarce Sagrada?) is official in the B. P., and given in 
the dose of 2 to 8 grains (0.1-0.5) in pill. 



CASSIA FISTULA. 

Cassia Fistula, JJ. S., is the fruit of Cassia Fistula, or Purging 
Cassia, as it is sometimes called, and occurs in long, dark-brown pods 
containing a dark pulp in each segment. This pulp is the useful part 
of the drug, and is official in the B. P. as Cassias Pulpa. Cassia 
fistula ought never to be used alone, as it is too apt to cause pain 
and griping, but it is officially present in the Confection of Senna 
(Confectio Sennce, JJ. S. and B. P.), and may be given in the dose of 
\ drachm to 1 drachm (2.0-4.0) as a laxative, or as much as \ ounce 
(16.0) may be used if a purgative effect is desired. 



CASTOR OIL. 

Castor Oil (Oleum Ricini, JJ. S. and B. P.) is a fixed oil derived 
by expression from the beans of Ricinus Communis, a plant of the 
United States and elsewhere, but originally derived from India. It 
contains an acrid substance, ricinoleic acid. 

Physiological Action. — The manner in which castor oil purges is 
somewhat in doubt, but its activity probably depends upon the pres- 
ence of the acid just named and the fact that it is an oil. 

As is well known, oils — such as olive oil, for example — if given in 
any quantity, tend to move the bowels, and the ricinoleic acid, which 
is somewhat acrid, stimulates the small and large gut, and so develops 



CASTOR OIL. 125 

peristaltic movement. According to some writers, this acid is not set 
free until the oil is attacked by the pancreatic juice. That this acid 
possesses purgative properties of itself seems proved by the fact that 
the oil will purge when it is rubbed in by the skin, and that nursing 
mothers on taking the oil eliminate the acid in the milk to such an 
extent that the suckling is purged. According to the studies of 
Rutherford and Vignal, the oil has no effect over biliary secretion 
other than that violent purgation indirectly increases the flow, and 
the researches of Hess have shown that the oil acts more rapidly in 
the small than in the large gut, and only produces peristalsis by 
coming in contact with the mucous membrane. 

Therapeutics. — Castor oil is the blandest and most unirritating 
purge we have, with the exception of the sulphate of magnesium, 
which is depletant and much more rapid in its effects. While the Epsom 
salt will act in one half to one hour if the stomach is empty, castor 
oil will generally act in four hours, or perhaps five. Its action is so con- 
stant that in many persons it acts with the regularity of a timepiece. 

Castor oil is used whenever irritant materials, such as bad food, 
putrid flesh, or decaying or green vegetables, have been eaten, even 
if the inflammation set up after them is very active. If hard bodies, 
such as broken cherry-stones, have been swallowed, castor oil is a far 
better purge than sulphate of magnesium, as it is more gentle and 
lubricates the gut, thereby preventing scraping and irritation. Where 
mucus has accumulated in the bowel in children, and must be gotten 
rid of before other treatment is resorted to, castor oil should be used. 
Previous to parturition it has been largely used to relieve the bowels 
of faecal matter, and is said by old practitioners to make the labor 
easier than if any other purge is used. It is also employed in the 
constipation following acute diseases and in that occurring in infants 
and children. 

The disadvantages of castor oil lie in its taste, the fact that it is 
oily, that it tends to produce hemorrhoids if used constantly, and 
finally that its frequent use, or even a single dose, is generally fol- 
lowed by more obstinate constipation than before, so that the dose 
must be rapidly increased in size to be effective. This is one of the 
reasons why it is useful in irritative diarrhoeas. The effect of castor 
oil is very much increased if a little bicarbonate of sodium is given 
with it. 

Administration. — Castor oil is very much more agreeable to the 
taste if pure than if poorly prepared. It is also true that too great 
purity renders it less active. 

The methods directed for taking castor oil are as various as the 
tastes of individuals. Its odor may be covered by a drop or two of 
the oil of bitter almonds, but emulsions of the oil are not of any ser- 
vice, save to interfere with its efficiency. Some take the oil in the 
foam of beer or porter, others in syrup of sarsaparilla and soda- 
water, and still others in milk or cream. A good way to take it is 
to eat one or two strong so-called cream peppermint drops, or even 
the crystalline peppermint drops, swallow the oil from a spoon which 
is to be placed well back in the mouth, and immediately eat several 



126 DRUGS. 

other peppermints. This plan is improved by using the oil in milk 
or water, so that the liquid carries the oil down into the oesophagus 
without its touching the mucous membranes. It may also be taken 
in highly seasoned beef-tea. Ringer recommends the following : -|- 
ounce (16.0) of oil, fresh syrup of acacia 3 drachms (12.0), and dis- 
tilled water 5 drachms (20.0), flavored with a little oil of lemon or 
peppermint. Wood advises that it be mixed with glycerin, equal 
parts, to which is added a drop or two of oil of gaultheria or oil of 
cinnamon. By far the best way of administering it is in soft capsules 
containing from \ to 1 drachm (1.0-4.0). Very few people are 
unable to swallow as much as a teaspoonful in capsule, and several 
of the smaller capsules may be given at once to complete the neces- 
sary dose. The capsules should be lightly dipped in water in order 
to render them slippery and so easily swallowed. 

The dose of castor oil for an infant is 1 to 2 teaspoonfuls (4.0- 
8.0), and for an adult \ ounce to 1 ounce (16.0-32.0). 

Owing to the fact that the oil will very frequently produce griping, 
a few drops of laudanum should be added to it, or tincture of bella- 
donna may be used. If these cannot be employed, a drop of the oil 
of cinnamon is equally useful for this purpose. 



CATECHU. 

Catechu ( U. S.) is derived as an extract from Acacia Catechu. 
The catechu of the U. S. P. is true catechu ; that of the B. P. is in 
reality an extract of gambier, being derived from the leaves and shoots 
of TJncaria G-ambier. Catechu depends for its medicinal use upon the 
astringent properties which it possesses. Beyond this power it has 
no particular value. 

It is of a dark-red color, has a somewhat sweetish taste, and is 
insoluble, like most extracts, in water. 

Therapeutics. — Like all the vegetable astringents, catechu is used as 
a remedy for diarrhoea, particularly that of the serous type or that in 
which the stools are of too fluid a consistency. If large amounts of 
mucus in the passages show a catarrhal state of the bowel, the mucus 
should be displaced by a purge of castor oil or sulphate of magnesium 
before the astringent is used. 

Catechu may or may not be combined with opium in cases of diar- 
rhoea, but the following prescription will be found of service in many 
instances : 

For an adult : 

R.— Tinct. catechu composit fgij (64.0). 

Tinct. opii camphoratse f^ij (64.0). 

Mistune cretse f|ij (64.0).— M. 

S — Dessertspoonful (8.0) every four hours till relieved. To be shaken before using. 

In cases of sore throat where the secretion is excessive and the 
inflammation subacute catechu may be used as a gargle. 

In cases of spongy gums catechu is sometimes useful as a mouth- 
wash. If the powdered catechu is used internally, the dose is 20 to 



CERIUM OXALATE. 127 

30 grains (0.1-2.0). The dose of the Compound Tincture of Catechu 
(Tinctura Catechu Composita, U. S.) is 1 to 2 fluidrachms (4.0-8.0). 
Its only constituent besides the catechu is cinnamon. The Troches 
of Catechu (Trochisci Catechu, U. S. and B. P.) are to be employed 
in sore throat, and are to be held in the mouth. They are not gen- 
erally used. 

The official preparations of the B.P., besides the ones given, are: 
Infusum Catechu, given in the dose of 1 to \\ nuidounces (32.0-48.0) ; 
the tincture {Tinctura Catechu), dose 1 to 2 fluidrachms (4.0-8.0); and 
a compound powder (Pulvis Catechu Compo situs), composed of catechu, 
kino, and rhatany, the dose of which is 20 to 40 grains (4.0-8.0). 



CAUSTIC POTASH. 

Caustic Potash (Potassa, TJ. S. ; Potassa Caustica, B. P.) is a very 
deliquescent, hard, white solid, possessing great caustic power, and 
used in medicine for the purpose of burning away growths or exube- 
rant ulcers. A piece of the drug should be placed on the skin by means 
of a pair of forceps, Avhen it will at once soften down and burn the 
tissues until it can reach no farther. The surrounding skin should 
be protected by wax, suet, or oils, and a piece of adhesive plaster 
with a hole for the growth should first be applied to prevent any 
action on the surrounding healthy tissues. The burn produced by 
caustic potash is very painful, and cauterization through its influence 
should not be practised if it can be avoided. When the caustic has 
acted sufficiently, it is to be washed off with vinegar or other dilute 
acid. Vienna paste (Potassa cum Calce, TJ. S.) is used for the same 
purpose as is caustic potash. 



CAUSTIC SODA. 

Caustic Soda (Soda, TJ. S. ; Soda Caustica, B. P.) is milder than 
caustic potash, and its action is more readily controlled. It should 
be used in the same way and for the same purposes as is caustic pot- 
ash, and the surrounding skin ought to be protected by adhesive 
plaster and oil or ointment. 

The soda must be kept in well-stoppered bottles made of hard, 
strong glass. The only official preparation of caustic soda in the 
TJ. S. P. is Liquor Sodce, or solution of soda. 



CERIUM OXALATE. 

Cerium Oxalate (Cerii Oxalas, TJ. S. and B. P.) is a white granular 
powder, permanent when exposed to the air, odorless and tasteless, 
and insoluble in water and alcohol, but freely so in hydrochloric acid. 

Therapeutics. — It is used instead of bismuth in the treatment of 
the vomiting of pregnancy or that due to uterine disorders and dis- 



128 DRUGS. 

placements, and in some cases of gastric acidity. The dose is from 
2 to 5 grains (0.10-0.3), given in pill form every four or five hours. 



CHENOPODIUM. 

Chenopodium ( U. S.) is the fruit of the Chenopodium Ambrosioides, 
or American wormseed. The seeds contain a volatile oil and have a 
distinct and rather disagreeable aromatic odor. These seeds, rubbed 
up into a powder, form with a syrup an electuary which is a most 
efficient remedy against the ascaris lumbricoides, or round-worm, as it 
occurs in children. The dose of the powdered seeds is from 10 to 30 
grains (0.65-2.0). The better way of using chenopodium is in the 
form of the oil {Oleum Chenopodii, U. S.) in the dose of 10 drops 
(0.65) to a child of five years, either on sugar or in an emulsion made 
of gum acacia. If the patient is old enough, capsules may be used. 
The general dietetic measures adopted for the removal of worms should 
be insisted upon before the drug is given. (See article on Worms.) 



CHIMAPHILA. 

Chimaphila ( U. S.), or Pipsissewa, is the leaves of Chimaphila 
Umbellata, an evergreen found in America, Europe, and Asia. 

Therapeutics. — Pipsissewa is a drug employed in atonic renal con- 
ditions, particularly of the functional type, as a stimulating diuretic, 
which will bring into activity the secreting structure of the kidney 
and the mucous membranes of the genito-urinary tract. It is also a 
tonic to the stomach. For this reason it is often placed in mixtures 
given to dropsical patients if debility and anorexia are present. In 
the treatment of ulcers of the skin due to struma it is said to be of 
service, and it probably has some slight alterative power. The drug 
may be used in the form of a decoction, which is not official, in the 
dose of 1 to 3 fluidounces (32.0-100.0), and as the fluid extract 
(Extr actum Chi map Mice Fluidum, U. S.) in the dose of ^ to 1 drachm 
(2.0-4.0). 

CHIRETTA. 

Chiretta (Chirata, U. S. and B. P.) is the plant Swertia Chirata, 
which is a native of India. It is a bitter tonic, possessing a very 
distinct influence over the liver, and. unlike many bitter tonics, is 
devoid of tannic acid. For this reason it may be used with prepara- 
tions of iron. Chiretta may be given in all cases of indigestion and 
loss of appetite, particularly where the liver is torpid or if any tend- 
ency to constipation is present, although it is not directly laxative. 
When given in powder the dose is 20 grains (1.3); the dose of the 
fluid extract (Extr actum Chirata? Fluidum, U. S.) is 30 drops to 1 
drachm (2.0-4.0), while that of the tincture (Tincturce Chiratce,U. S. 
and B. P.) is 1 to 4 drachms (4.0-16.0). The unofficial solid extract 



CHLORAL. 129 

may be given in pill in the dose of 2 to 4 grains (0.1-0.2). The dose 
of the infusion (Infusum Chiratce, B. P.) is a wineglassful (32.0). 



CHLORAL. 

Although the name Chloral is applied to the substance used in 
medicine, chloral proper is never so employed, hydrate of chloral 
{Chloral Hydras, B. P. ; Chloral, U. S.) being the real preparation. 
Chloral hydrate is a white, crystalline body, but is often sold in irreg- 
ular broken masses, which are generally impure. It should be kept 
in tight bottles in a cool, dark place. 

Physiological Action. — When chloral is applied to a mucous mem- 
brane it causes distinct reddening and burning pain, and finally acute 
inflammation. It is, therefore, a local irritant. Chloral acts in the 
body as chloral, and is not broken up into formic acid and chloro- 
form, as was taught at one time. 

Nervous System. — In medicinal and toxic dose chloral produces 
sleep by quieting the intellectual centres in the brain, at the same 
time depressing the motor tract of the spinal cord and the motor 
nerves. In medicinal amounts it does not decrease sensation, but in 
toxic dose it does. Very often hyperesthesia results from small doses. 
Reflex action is decreased by its influence on the motor portions of 
the spinal cord. 

Circulation. — A dose of 10 to 20 grains (0.65-1.3) in the adult 
rarely causes any circulatory changes, but larger amounts produce a 
fall of arterial pressure and a slow, feeble, or sometimes a rapid-run- 
ning pulse, due to a direct depression of the heart-muscle, for chloral 
in overdose is a cardiac paralyzant. 

After death from chloral the blood may be found dark and grumous- 
looking, with the corpuscles broken down, but these changes occur 
only after very large doses. 

Respiration. — In moderate amounts no respiratory eifect is felt, 
but in toxic doses the breathing becomes slower and slower and more 
and more shallow, until it stops in death. When death is caused by 
chloral it is due to respiratory failure, with an almost simultaneous 
arrest of the heart. 

Temperature. — Chloral tends to lower bodily heat, and in large 
doses produce a very marked fall of temperature, which does much 
toward causing death. Brunton has found that rabbits will survive 
very large doses of the drug if external heat is supplied to them. 
The fall of temperature is, at least in part, due to the failure of the 
circulation and vascular dilatation. 

Kidneys, Tissue-waste, and Elimination. — Chloral is elim- 
inated by the kidneys in the form of uro-chloralic acid and, if given 
in excess, as chloral. Large amounts irritate these organs, and may 
produce bloody urine, owing to the nephritis which is set up as the 
drug passes through the renal structures. After chloral is ingested 
the urine of a patient will often give Fehling's test for sugar. 

Poisoning. — When a poisonous close of chloral is taken by man, the 



130 DBUGS. 

person soon falls asleep and then sinks into a deep coma. The respira- 
tions become at first slow and labored, then shallow and feeble. The 
pulse, at first perhaps a little slowed, soon becomes rapid, thready, and 
shuttle-like, and is finally lost at the wrist. The face is white and livid, 
the forehead and the hands covered with a cold sweat, and the pupils, 
which are at first contracted, soon become widely dilated. Absolute 
muscular relaxation is present, and it is impossible to arouse the 
patient. 

Treatment of Poisoning. — The physician should apply external 
heat and use emetics in the early stages, or, if the case is seen too late 
for emetics to act because of systemic depression, he should use the 
stomach-pump. This latter means of removing the drug from the 
stomach is more reliable and safer, because the production of vomit- 
ing may result in efforts which will strain the heart. Strychnine 
should be given in full dose, -^ to ^ of a grain (0.003-0.006), to 
stimulate respiration, or atropine may be used for the same purpose. 
The heart is to be supported by 10-drop (0.65) doses of tincture of 
digitalis, given hypodermically every twenty minutes until some effect 
is noted ; and, as the digitalis is rather slow in its action, it may be 
preceded by ether and ammonia or brandy or whiskey. The patient 
must not raise the head to vomit, and the head should be placed on a 
lower level than the heels to keep up the circulation of blood in the 
brain. 

In chronic poisoning by chloral or in cases in which the patient has 
come to use the drug as a habit the patient suffers from weakness, men- 
tal and physical, with sudden flushings due to vasomotor disorder, from 
palpitation of the heart, and finally from petechial eruptions, bed-sores, 
ulcerations, and sloughs. The following prescription may be used : 

K.— Chloralis . . . gij vel iv (8.0-16.0). 

Morphinee sulphatis gr. ij (0.1). 

Syr. lactucarii (Aubergier) . . . . 13 ij (64.0). 

Aquae. . . . . . . . q. s. ad fgiij (96.0).— M. 

S. — Dessertspoonful (8.0), in water, at 10 and at 11 p. m., if necessary. 

Therapeutics. — Chloral is the purest hypnotic that we have, and 
may therefore be used where simple nervous insomnia is present, but 
not when sleeplessness is due to pain. Under such circumstances it is 
to be employed in the combination of 10 grains (0.65) of chloral with 
^ of a grain (0.01) of morphine, as a much more powerful hypnotic 
effect is produced by the combined action of the two drugs than by 
the use of either one of them alone. 

In tetanus and strychnine poisoning chloral is the best remedy we 
have, as it depresses the motor tract of the spinal cord. In such a 
case it should be given in 20-grain (1.3) doses combined with 60 grains 
(4.0) of bromide of potassium. If the convulsion prevents deglutition 
or is brought on by swallowing, the remedy should be used by the 
rectum ; and if the spasm expels it from the rectum, the patient should 
be chloroformed long enough to alloAv the injection to be given and 
absorbed. The same remedies in small doses are to be used in infan- 
tile convulsions and in infantile colic in the dose of \ grain to 1 grain 
(0.03-0.06) of chloral to 2 grains (0.1) of bromide of potassium or 



CHLORALAMIDE. 131 

sodium in a teaspoonful of peppermint-water. In chorea, paralysis 
agitans, and delirium tremens chloral is of great service, but must be 
given cautiously in the latter condition, for fear it may depress the 
heart, which is already diseased by alcoholic excess. Cases are on 
record where chloral has caused sudden death from cardiac failure in 
the persons of alcoholics with fatty heart — an accident the liability to 
which is increased by the fact that owing to the addiction of the pa- 
tient to a narcotic drug it requires large doses to produce sleep. In 
urcemic convulsions it has been highly extolled, but if any acute renal 
trouble is present, it must not be used, lest it irritate the kidneys. 
In puerperal convulsions not dependent upon nephritis 20 to 30 
grains (1.3-2.0) of the drug may be given, and repeated in one 
■or two hours. 

Hiccough, nocturnal epilepsy, and whooping cough are all indi- 
cations for its use, but in asthma it rarely does good, and if pushed 
is dangerous to the heart. 

Untoward Effects. — Chloral sometimes causes nausea, purging, and 
vomiting by reason of its irritant action. In susceptible persons doses 
of 10 to 15 grains have produced marked redness of the eves with 
swelling of the conjunctiva. Sometimes these symptoms are only 
produced when an alcoholic beverage is taken simultaneously. 

Administration. — Chloral is best given in syrup of acacia, simple 
syrup, or water. It should be always well diluted. The syrup of 
chloral (Sgrupus Chloral, B. P.) is given in the dose of 1 nuidrachm 
(4.0). The following prescription is useful in insomnia: 

R.— Chloralis . . /# gj vel ^ij (4.0-8.0). 

Potassii bromidi gij (8.0). 

Syr. pruni virginianse f ^j (32.0). 

Aqua- q. s. f g'iij (96.0).— M. 

S. — Dessertspoonful (8.0) at night. 

Sometimes chloral can be well given in junket by adding it to a 
liquid rennet, and then adding the ferment to milk. (See Junket, 
Part III.) The question as to the safe dose of chloral is one largely 
governed by the susceptibility of the patient, but alarming symptoms 
have followed a dose of 30 grains, and death after from 30 to 45 
grains. Thirty grains in twenty-four hours is certainly ample. 

CHLORALAMIDE. 

Chloralamide is a compound very recently introduced into medi- 
cine, formed by the addition of formamide to anhydrate of chloral, 
and is a colorless crystalline substance, soluble in 9 parts of water 
and 1J parts of alcohol. Its taste is slightly bitter, but not biting, 
and it keeps well in watery solution without decomposition. Its 
physiological action is closely allied to that of chloral, except that it 
is not quite so depressing to the circulation. Upon the nervous sys- 
tem it acts chiefly upon the brain and spinal cord, and produces sleep 
— a result to be expected, since both chloral and formamide are hyp- 
notics. It is said not to irritate the stomach and kidneys, but it 
probably is only less irritant than chloral. 



132 DRUGS. 

Therapeutics. — Chloralamide may be employed in medicine when- 
ever chloral may be used. It is decidedly a nervous sedative, and in 
the wakefulness of nervous insomnia is very useful. Sleep generally 
ensues about thirty to forty-five minutes after it is taken. According 
to most of the reports published so far, the drug relieves pain as well 
as produces sleep, and is therefore distinct in its actions from chloral. 
In neuralgia it is very useful, and it has been found of value in the 
pains of tabes dorsalis. The dose is 10 to 30 grains (0.65-2.0), which 
may be repeated in three or four hours, although the sleep generally 
lasts five to eight hours. The following formula may be used for its 
administration : 

R.— Chloralamide gr. xl (2.65). 

Acid, hydrochlorici dil. gtt. v (0.3). 

Syrnpi . f.^ij (8.0). 

Aquae dest. . . f^ij (64.0).— M. 

S. — Take in two doses in a little water. 

Very recently, Charteris has obtained very extraordinary results 
in the treatment of sea-sickness by the use of chloralamide and bro- 
mide of potassium. He gives it in the dose of 30 grains (2.0) with 
an equal amount of the bromide. It is necessary for the patient to 
take a cholagogue for tw T o days before starting on his voyage, and as 
soon as he gets on board to take the dose named on an empty stom- 
ach, and at once to go to bed and to sleep. If this is done, Charte- 
ris claims that the patient will awake feeling bright and well, and 
remain so for the rest of the voyage. 



CHLORALOSE. 

Chloralose is a compound made from anhydrous chloral and glu- 
cose, is soluble in hot water and alcohol, and was introduced into 
medicine as a safe hypnotic and substitute for chloral. Unfortu- 
nately, its taste is acrid, and to some persons nauseous, particularly 
if taken in water. 

Physiological Action. — The physiological action is practically iden- 
tical with that of chloral, but much more mild if the researches of 
Mosso are correct. Its dominant effect is on the brain, and full doses 
depress the spinal cord and heart. Poisonous doses may produce 
hemoglobinuria. 

Therapeutics. — The indications for the drug are functional insom- 
nia, and the beginning dose is 2 to 7 grains (0.1-0.5), but the smaller 
dose should always be tried first, particularly in women. Sleep fol- 
lows its ingestion in about half an hour. 

The best w T ay to administer the drug is to give it in capsules or 
cachets, and follow 7 it with a glass of water or milk. 

Untoward Effects. — Sometimes chloralose produces diplopia, muscu- 
lar tremors, or constant passing of the hands over the head and face. 
If a habit is induced by its .constant use, it is a noteworthy fact that 
its power to produce sleep is decreased, while the untoward effects are 
more likely to be marked. 



CHLORATE OF POTASSIUM. 133 

CHLORATE OP POTASSIUM. 

Chlorate of Potassium (Potassii Moras, U. S. and B. P.) is a 
salt of potassium differing entirely in physiological action from all 
the other potassium salts, and, with the exception of the cyanide of 
potassium, is certainly the most poisonous. Not only is it, when 
locally applied, an irritant to mucous membranes, but when it is 
absorbed into the blood it causes changes of a serious character in 
this fluid, and produces acute nephritis if given in overdose. 

Caution should be used in handling this drug, as if it comes in 
forcible contact with organic matter explosion may occur. 

Physiological Action. — It has been thought by some that chlorate 
of potassium gives up a large amount of oxygen to the body, and that 
for this reason it would be of value in cases of slow asphyxia, such 
as result from pneumonia or phthisis. It has even been recommended 
to persons crossing high mountains where the rarity of the air pro- 
duced disagreeable effects; but nothing is more absurd than the 
belief that it gives up oxygen to the body. Chlorate of potassium 
does give oif oxvgen when treated with verv high heat, but not at 
the temperature of the body. Nearly all of it escapes from the body 
unchanged. 

When overdoses of the chlorate are taken, it produces sickness of 
the stomach, headache, pain in the loins and belly, dyspnoea, cyano- 
sis, heart-failure, and great weakness. The blood is dark and choco- 
late-looking, this change being due to the production of methaemo- 
globin. The blood-corpuscles are crenated and broken down, and the 
liver, kidneys, spleen, and intestines are found softened and filled 
with broken-down and disorganized blood. 

Therapeutics. — Chlorate of potassium is useful in stomatitis and in 
mercurial sore mouth as a mouth-wash, or, given internally, in the 
following mixture : 

R. — Potassii ehlorat. gr. xlviij (3.0). 

Tr. myrrh f^ss (2.0). 

Elixir calisayse q. s. ad f^iij (96.0). — M. 

S. — Teaspoonful (4.0) every five hours, or use as a mouth-wash. 

Owing to the fact that the drug is eliminated by the saliva to a 
great extent, the mucous membranes affected by stomatitis are con- 
stantly bathed by a solution of the chlorate when it is taken by the 
stomach. If any irritation of the stomach or kidneys exist, the medi- 
cament must be used on a swab and none of it swallowed. 

In dipMheria chlorate of potassium is very commonly employed, 
hut its use is exceedingly dangerous. Death in many cases of diph- 
theria is due to the renal irritation present, or, in other words, to an 
acute nephritis, and this drug simply increases the inflammatory pro- 
cess. If the chlorate of potassium is employed in diphtheria it 
should be used in solution and applied by means of a swab. (See 
Diphtheria.) 

In anginose sore throat chlorate of potassium is a useful gargle, 
and Wood recommends the use of a solution made by adding 1 ounce 



134 DRUGS. 

(32.0) of sumach-berries, J ounce (16.0) of chlorate of potassium, and 
1 pint (500.0; of boiling water to each other, and allowing them to 
simmer for a few hours, when the mixture should be strained, -cooled, 
and used as a gargle. 

The following is equally serviceable : 

R— Potassii chlorat. £j (4.0). 

Ext. rhois glabrae fl f^ss (16.0). 

Aquse dest q. s. ad f §iij (96.0). — M. 

S. — To be added to an equal quantity of water in a glass and used as a gargle every 
two hours. 

This prescription makes an abominable-looking pharmaceutical 
preparation, but an exceedingly useful one. 

In acute rectal catarrh with mucous diarrhoea and tenesmus a 
solution of chlorate of potassium in water, 20 grains (1.3) to the 
ounce, injected into the bowel, will often produce a cure after one or 
two injections. Not more than 4 ounces (128.0) should be used, and 
it ought to be retained for twenty minutes. Often it will be well to 
add the saturated watery solution of the chlorate to an equal quantity 
of starch-water, as the latter aids in allaying the local irritation. 
In the treatment of hemorrhoids a few drops of laudanum added to 
this solution will be found of great service. The troches (Trocliisci 
Potassii Chloratis, U. S. and B. P.) are given in the dose of 1 to 6, 
each lozenge containing 5 grains (0.3). They are intended to affect 
the oral mucous membrane, but are apt to disorder the stomach by 
reason of the drug being swallowed in the saliva. 



CHLORIDE OP SODIUM. 

Chloride of Sodium (Sodii Chloridum, U. S. and B. P.), or Com- 
mon Salt, is a useful drug and food, aiding in maintaining the alka- 
linity of the blood and tissues and in the formation of gastric juice, 
being changed by the lactic acid of the stomach into lactate of 
sodium, thereby setting free hydrochloric acid, which acts not only 
by aiding digestion, but in the production of pepsin from the pep- 
sinogen of the gastric tubules. The dose is 10 to 20 grains (0.65-1.3). 



CHLORIDE OP ZINC. 

Chloride of Zinc {Zinci Chloridum, U. S. and B. P.) is a white, 
crystalline, deliquescent powder, of caustic taste and acid reaction, 
possessing considerable disinfectant power. It has been used as an 
eye-wash in the strength of 1 to 2 grains to the ounce (0.06-0.10 ; 
32.0), but is rarely so employed at present. The same solution may 
be used as an injection in the second stage of gonorrhoea. Under 
the name of Liquor Zinci Chloridi, U. S. and B. P., is prepared a 
strong solution of the salt for disinfectant purposes of the strength 
of about 50 per cent. 



CHLORINATED LIME. 135 

Numerous experiments with the proprietary " chlorides " show 
them to be possessed of very slight disinfectant power, but to be 
strongly antiseptic. 

CHLORINATED LIME. 

Chlorinated Lime (Calx Chlorata, U. S. ; Calx Chlorinata, B. P.) 
is the hydrate of lime, containing 35 per cent, of chlorine, provided 
it is of official strength. It is an exceedingly irritant substance 
because of the chlorine which it contains, and is never used inter- 
nally. 

Much of the chlorinated lime sold is useless, containing too little 
or no free chlorine. Good chlorinated lime should be so laden with 
the gas that the face cannot be held near it without the eye being 
severely irritated. Unless the chlorine is present, the substance is 
of no value, for its employment as a disinfectant depends upon the 
action of this gas, the lime being used merelv as a vehicle and oxi- 
dizer, the gas by itself being difficult of application. 

Uses. — As a disinfectant for privies, drains, and sinks chlorinated 
lime is one of the best, if not the best, we possess. A few pounds 
of it may be added every week to the contents of a privy vault with 
great advantage, and a solution of it may be used in all bed-pans and 
urinals. When the passages of a patient having typhoid fever are to 
be received in a bed-pan, a chlorinated-lime solution should be placed 
in the receptacle beforehand, so that the fecal matter or urine will 
fall at once into a disinfecting fluid. The solution should be of the 
strength of 1 pound to 2 gallons. As it is one of the most powerful 
deodorizers, chlorinated lime should be placed liberally about decay- 
ing animals, and in exhuming corpses sheets wrung out in a solution 
made as above will be found of service to destroy the stench if 
wrapped about the body. 

Water which has become foetid by stagnation may be rendered 
drinkable by adding 1 to 2 ounces of the chlorinated lime to every 
65 gallons, and standing the solution aside for some hours until pre- 
cipitation and exposure to the air have gone on for some time. 

It should be remembered that chlorine fumes will bleach many dyed 
goods. 

Chlorine gas, in a diluted form, has been used for the treatment of 
aphonia due to cold in cases where the aphonia persists for some 
months. It can be obtained by allowing a few drops of hydrochloric 
acid to fall upon chloride of lime or chloride of sodium. 

The placing of chlorinated lime in saucers about sinks and closets 
is useless, as the amount of chlorine liberated is very slight as com- 
pared to the volume of air in the room. Where the chlorine is pres- 
ent in a sufficiently concentrated form to kill germs, it will also kill 
the occupant of the chamber. A deodorant effect may be obtained, 
but a bad smell, if it exists, even when overcome by a greater one, 
is not really gotten rid of. The official preparations of the B. P. are 
Liquor Calcis Chlorinatce and Vapor Chlori. 



1 36 DB UGS. 



CHLORODYNE. 



Chlorodyne is a preparation used to a very large extent by the 
English for the treatment of serous diarrhoeas or cramps in the stomach. 
Even in England its constitution varies considerably, but the formula 
mast commonly used is as follows: 

R. — Morphinse hydrochlor. . . gr. viij (0.5). 

Aqua? dest fgss (2.0). 

Heat together, and as soon as the morphine is dissolved and the liquid cooled, add 

Acid, hydrochlor. dil fgss (2.0). 

Chloroformi . . _ f ^iss (6.0). 

Tr. cannab. indicse f^j (4.0). 

Acid, hydrocyanic, dil Tr\,xij (1.0). 

Alcoholis . ._ f§ss (16.0). 

Gl. rnenth. piperit ^xij (1-0). 

Oleoresinse capsici Try (0.05). — M. 

S. — 5 to 15 drops (0.35-1.0) for an adult, in water, every two hours for three doses. 
More than this quantity is dangerous. 



CHLOROFORM. 

Chloroform was originally discovered by Guthrie of Sackett's Har- 
bor, New York, but first brought into medicinal use by Simpson of 
Edinburgh. It is a clear liquid of an exceedingly hot, burning, 
sweetish taste, of a rather agreeable odor,- and is very volatile in the 
presence of ordinary air. 

There are two kinds of chloroform — the purified {Chloroformum 
Purificatum, U. S.) and the 'commercial chloroform {Chloroformum 
Venale). Chloroform should be kept in a dark, cool place. 

If exposed to the light for any length of time, chloroform develops 
hydrochloric acid and certain gases which render it unfit for use. If 
impure because of improper methods of manufacture, an oily odor 
will be left on the hand after evaporation takes place. Under these 
circumstances the methods of purification directed by the U. S. P. 
should be followed in order to avoid untoward effects. Even these 
methods, however, do not give us of necessity a perfectly pure chloro- 
form. The methods and researches now carried out by Pictet prob- 
ably give us the safest and purest article. 

Chloroform vapor in the presence of gas flame undergoes certain 
changes which result in the development of noxious and irritating 
fumes, consisting principally of hydrochloric acid, which produces 
laryngeal and bronchial irritation. 

Physiological Action. — Locally applied to the skin, chloroform may 
produce some tingling and burning, even if evaporation be not inter- 
fered with. If it be confined under a watch-glass on the skin, it will 
cause a blister and act as a counter-irritant. 

When inhaled, chloroform produces a sensation of warmth in the 
mouth and throat, a feeling of relaxation, and finally unconsciousness. 
The respirations are at first full and deep, but soon become more 
rapid and shallow. The pulse may be somewhat stronger and fuller 
for a short interval, but soon fails in strength and becomes more 



CHLOROFORM. 137 

rapid. The irritation produced in the air-passages by its inhalation 
is very slight, and no primary arrest of respiration ensues, as is gen- 
erally seen after ether is first given. The pupils are at first slightly 
dilated, but are contracted during anaesthesia. If the pupils dilate 
during the use of chloroform after the contraction just named, danger 
is imminent and death mag suddenly occur. In some persons the first 
effects of chloroform are violent struggles, and there is danger in try- 
ing to overcome these struggles by pushing the drug very rapidly. 
This is particularly apt to be the case in athletes and drunkards. 
Total muscular relaxation should never be caused by the drug. 

Nervous System. — Chloroform first affects the brain, then the 
sensory part of the spinal cord, then the motor tract of the cord, 
then the sensory paths of the medulla oblongata, and finally the 
motor portion of the medulla, thereby producing death from failure 
of respiration unless, as rarely occurs, the heart has already suc- 
cumbed to the drug. On the sensory and motor nerves, when locally 
applied, it acts as an irritant and anaesthetic. Upon these nerve- 
trunks, when taken by inhalation, it has little effect. 

Circulation and Respiration. — To any one who endeavors to 
view the subject of chloroform anaesthesia in an entirely impartial 
light two objects raise themselves so high above all others that they 
form the peaks about which the smaller questions must cluster. The 
first object on which the judicial eye rests is the firm belief of many 
clinicians that chloroform may cause sudden cardiac death ; the 
second object to be seen is the statement of the Hyderabad Chloro- 
form Commission that death from chloroform is never due to cardiac 
failure. In the support of the first belief we have not only wide 
clinical observation, but also the experimental evidences of a number 
of investigators. In support of the second statement we have an 
array of experimental study not equalled by any other research 
extant, associated with an enormous number of negative observations 
on man — negative observations, because Lawrie alone in twenty-five 
thousand cases has never had a cardiac death. 

The controversy concerning the action of chloroform upon the 
animal organism has been waged so incessantly for many years, and 
has led to such extraordinary efforts for its elucidation and final 
decision, that any one who attempts to take part finds himself almost 
swamped by the number of statements and opinions which he is 
forced to regard. 

In March, 1892, Surgeon Lieutenant-Colonel Lawrie, whose inter- 
est in this subject is recognized by the medical profession the world 
over, wrote to the author asking that another chloroform research be 
instituted, for which the government of His Highness the Nizam of 
Hyderabad would pay. 1 The express object of the research was the 
reconciliation of at least some of the contradictory conclusions reached 
by various experimenters during the past few years. 

From the immense number of observations in regard to the action 

1 The report to the government of Hyderabad was made by the author and Dr. E. 
Q. Thornton in a joint paper, April, 1893, and published in the Therapeutic Gazette, 
October, 1893. 



138 DRUGS. 

of chloroform in the laboratory and in the operating-room it is evi- 
dent that sufficient data are at hand to give us material to reach 
positive conclusions, and that the contradictory results hitherto 
obtained must have been reached by misinterpretation and error in 
experimental method, tinctured perhaps by opinions formed previous 
to the completion of a line of study. There are certain facts in 
regard to chloroform which few will deny, the chief of which are 
that it has the advantage of rapid action without disagreeable pre- 
liminary or subsequent symptoms, its bulk is small, and its odor 
agreeable ; but, more important than all, it is much more dangerous 
than ether. 

There are certain other points in regard to the action of chloro- 
form which may be put aside as settled, and therefore not needing 
further study, being generally received as beyond criticism. Thus, 
all investigators concur in the statement that chloroform, even in 
ordinary therapeutic quantity, acts as a powerful and constant 
depressant to arterial pressure. This conclusion has been reached 
by Bowditch and Minot and Coats, H. C. Wood and the author, Gas- 
kell and Shore, the Hyderabad Chloroform Commission, Nos. 1 and 
2, and by every experiment in the author's latest studies. There is 
no evidence to the contrary, and practically it has never been denied. 
Gaskell and Shore state, however, that chloroform may cause anaes- 
thesia without lowering blood-pressure, and that chloroform causes 
primarily a rise of pressure. They also believe that the chief cause 
of the fall of arterial pressure is cardiac and not vasomotor depres- 
sion. The rise the author has never seen except from struggles, and 
he has never been able to produce anaesthesia without lowering the 
blood-pressure, even when the drug was used in the smallest quantity 
capable of causing anaesthesia and given as slowly as possible. The 
author agrees with the statement of the Hyderabad Commission that 
a fall of blood-pressure always occurs when chloroform anaesthesia is 
produced. 

Secondly, it is not denied by any one that we know of that chloro- 
form exerts a powerful depressant, paralyzant action on the respiratory 
centre. This is agreed to by clinicians and by every one who has 
experimentally studied the action of the drug on the lower animals. 

Thirdly, it is universally conceded that chloroform is a lethal agent 
of great power when brought in direct contact with highly-vitalized 
tissues. 

From a careful study of the experiments so far reported, from 
studies made by the author some two years ago with H. C. Wood, 
and, finally, from the more recent series of experiments, the author 
believes that the question as to whether death under chloroform is 
cardiac or respiratory can be settled by the acceptance of both views 
in a modified form, or, in other words, that there is no real antag- 
onism in the beliefs that chloroform kills by depression of the heart 
or depression of the respiration. 

The author very positively asserts that chloroform always kills 
by failure of respiration when administered by inhalation, provided 
— and this provision is most important — that the heart of the anaes- 



CHLOROFORM. 139 

thetized is healthy and has not been rendered functionally incompe- 
tent by fright or violent struggles or, again, by marked asphyxia. 
By a healthy heart he means one which has not undergone true fatty 
degeneration, or has not so severe a valvular lesion as to make the 
slightest variation in the even tenor of the circulation fatal. 

As positively as he asserts that chloroform kills primarily by respi- 
ratory failure, so does he also assert that in excessive dose by inhala- 
tion it has a depressant effect on the circulation, which is chiefly due 
to centric vasomotor depression, with final depression of the cardiac 
muscle itself. Depression of the cardiac muscle alone is never great 
enough to cause death when the chloroform is given by inhalation, 
but the author believes that gradual asphyxia, with the direct depres- 
sion of the circulation, may do much toward producing a fatal result, 
for vasomotor integrity is almost as necessary to life as an intact car- 
diac mechanism. This circulatory depression has been considered a 
safeguard, because it was supposed to prevent chloroform going to the 
vital centres ; but in reality it is no safeguard, because profound cir- 
culatory depression is as great an evil as respiratory narcosis. The 
circulatory depression may be so profound that recovery is impossible 
even with the most thorough artificial respiration. This emphasizes 
the fact that the surgeon cannot afford to totally ignore the effect of 
chloroform on the circulation, and we cannot consider the patient in 
danger of circulatory failure only when the respiration ceases, but 
as soon as it becomes abnormal. On the other hand, we should 
remember that, even if chloroform has been given properly, the arte- 
rial pressure may be so low as to give no pulse in the radial artery, 
and yet the circulatory system be ready to respond at once when the 
drug is removed. 

If, therefore, the chloroform is properly administered, is there 
danger of its circulatory effect in man ? The author thinks that it 
is just at this point that his researches and every other research on 
animals fails, and necessarily fails, to produce a positive reply. The 
variation in the action of a drug on a diseased individual from its 
effect on the normal one is notorious, and we have no right to dog- 
matically assert that there is absolutely no danger of circulatory 
depression in man, even if we found no evidence of failure in dogs, 
because there may be many idiosyncrasies or variations, through dis- 
ease in the human being, which may completely reverse the results 
of experiments on healthy animals. 

In other words, supposing that the amount of depression from very 
fall doses of chloroform equals twenty-five units, this amounts to little 
in the normal heart ; but if the heart be depressed twenty-five addi- 
tional units by disease, the depression of fifty units may be fatal, par- 
ticularly if to this fifty is added twenty-five units more of depression 
through fright and cardiac engorgement, through the disordered res- 
piration or struggling. That true depression of the heart-muscle may 
take place under chloroform seems to us most undoubted, and we think 
that the tracings in every research that we have seen support this 
view. There is always a decrease in cardiac power manifested by the 
decrease in the force of the individual pulse-beat, and this passes 



140 DRUGS. 

away only if chloroform is removed early enough. The author also 
agrees with McWilliams that from the very first inhalation of chloro- 
form there is a constant tendency to cardiac dilatation. 

Blood. — Upon the blood in the body chloroform has little or no 
effect when it is inhaled. Shaken with chloroform in a bowl outside 
the body, the blood becomes scarlet in hue. 

Temperature. — Chloroform when taken by inhalation distinctly 
lowers the bodily temperature, probably by aiding in the dissipation 
of heat and by its action on the nervous mechanism of heat-produc- 
tion. 

Elimination takes place by the lungs and by the kidneys, and 
goes on very rapidly, owing to the great volatility of the drug. 

If large amounts are eliminated by the kidneys, these organs are 
apt to become irritated and inflamed. 

Antiseptic Power. — Salkowski has investigated, after Koch's meth- 
ods, the degree to which chloroform-water acts upon micro-organisms. 
He has also used chloroform for some years to prevent urine from 
decomposing before he had time to examine it. Chloroform prevents 
all fermentations which depend upon the growth of micro-organisms 
— e. g. alcoholic fermentation, ammoniacal fermentation of urine, con- 
version of hippuric acid by fermentation into benzoic acid and glyco- 
col, lactic-acid fermentation, and the putrefaction of albumins — but 
it has no action on those processes caused by unorganized ferments, 
as ptyalin, pepsin, etc. 

Chloroform-water may be used to prepare solutions for subcuta- 
neous injections, and be given internally in diseases of the digestive 
organs depending on the presence of micro-organisms — among others, 
cholera. Possibly the benefit that many patients derive from sto- 
machic mixtures which contain chloroform-water is due to its destruc- 
tive action on various micro-organisms. Salkowski gave a dog 200 
cubic centimetres (about 6 J ounces) of chloroform-water with its food 
for four days without producing any ill effect, so that in the treat- 
ment of a disease like cholera large quantities of chloroform-water 
might be given. It may also be employed as a mouth-wash. 1 

Untoward Effects. — Sometimes during the administration of chlo- 
roform the heart or respiration suddenly ceases to act, and in some 
cases this change is preceded by a peculiar shade or cloud which 
passes over the face of the patient. Death may come suddenly and 
without an} 7 warning. If untoward effects appear, the anaesthetic 
must be at once withdrawn and artificial respiration resorted to. 2 

1 Chloroform-water is to be made by adding 1 fluidrachm of chloroform to 25 
ounces of distilled water. The mixture is then put in a well-stoppered bottle, and 
shaken thoroughly until the chloroform is dissolved in the water. The dose is gener- 
ally J to 2 ounces. The official chloroform-water is a saturated solution. 

2 While few text-books give any specific directions concerning the practical appli- 
cation of the methods which are to be employed in such emergencies, those that do so 
force the physician to a procedure at once dangerous and impractical ; for the direc- 
tions usually given are, to place the positive pole of the battery on the phrenic nerve 
as it crosses the anterior scalene muscle at the root of the neck, the negative pole 
being pressed against the lower margin of the ribs._ A rapidly-interrupted current is 
now to be used with the purpose of causing contraction of the diaphragm by the direct 
action of the electricity upon the nerve. Even theoretically this is a possible source 



CHLOROFORM. 141 

Injections of ether and hot brandy should be given beneath the skin, 
and the poles of a battery with a rapidly-interrupted current swept 
over the body, but not held over the phrenic nerve and diaphragm. 
The patient must be held head downward, so that the blood will flow 
to the brain, and active artificial respiration practised for a long 
period of time as the most important measure for the patient's relief. 
External heat should be applied. Atropine, strychnine, and digi- 
talis may be used to stimulate the heart and respiration. Of these 
strychnine is the most valuable. (See directions under the article on 
Ether.) 

The measures adopted for resuscitation should not be stopped for 
at least one hour, as persons have recovered as long as this after an 
accident from chloroform. 

Ostertag has found that very prolonged inhalations of chloroform 
in the lower animals produce widespread fatty degeneration. 

Therapeutics. — The first and most important use of chloroform is 
as an anaesthetic, and at this point we come to a question which has 
been for many years a matter of contention between different sections 
of the medical profession — namely, as to whether its use is very dan- 
gerous. In the Southern and Western parts of the United States 
chloroform is nearly always used, but in the Eastern and Northern 
portions it is rarely employed. Southerners certainly seem to take 
chloroform better than Northerners or those living on the Atlantic 
coast. It is impossible to go into a general discussion of the question 
here ; suffice it to state that even the most enthusiastic supporters of 
the use of chloroform confess that it is a more dangerous drug than 
ether if carelessly used, and, while the advantages of chloroform are 
many, this one great disadvantage overshadows them all. The advan- 
tages are — its more agreeable odor and the fact that it does not irri- 
tate the air-passages, owing to the small amount necessary to cause 
anaesthesia ; the fact that it is less apt to be followed by nausea and 
vomiting ; the rapidity of its action ; and the small bulk which has 
to be carried by the surgeon. Its disadvantages are — the possibility 
of its killing the patient by sudden cardiac failure and the power- 
fully depressing influence which it exercises over the respiratory 
centres. 

We come, finally, to the all-important questions : 

1. Is chloroform a safe anaesthetic ? 

2. Are we to watch the pulse or respiration during the use of the 
drug, and what are the signs in the respiratory function indicative of 
danger to the patient ? 

3. What is the true cause of death from chloroform ? 

4. Is death from chloroform possible when it is properly admin- 
istered ? 

of danger, and practically the writer has proved danger to be ever present under such 
treatment. The cardiac inhibitory nerves run so closely to the phrenic fibres, and 
respond so readily to electrical stimulation, that it is hard to imagine how they can 
escape stimulation if a current be used of sufficient strength to excite the phrenic 
nerves near by. By practical experiment the writer has proved that inhibition of 
the heart may not only be possibly brought about by this method, but that it is nearly 
impossible to avoid such an effect if the phrenics are to be reached at all. 



142 DRUGS. 

5. Under what circumstances is the surgeon to use chloroform in 
preference to the less dangerous anaesthetic, ether ? 

6. What is the best way of administering chloroform ? 

To the first question the answer is, Yes for the majority of cases, 
provided it is given by one who is skilled in its use, and not only 
knows how to give it, but how to detect signs of danger. It is not so 
safe as ether at any time, other things being equal, and never safe in 
the hands of a tyro. 

To the second question the answer is, Watch the respiration, 
because as soon as enough chloroform is used to endanger the circula- 
tion the respiration will show some signs of abnormality, either in 
depth, shallowness, or irregularity. In other words, the very effect 
of the drug may be to cause such deep and rapid respirations that an 
excessive quantity of the drug is taken into the lungs and continues 
to be absorbed even after the inhaler is withdrawn. 

As there is always a fall of blood-pressure under chloroform, it is 
difficult to feel the radial or temporal pulse, and the respiratory cen- 
tre recognizes the degree of arterial depression which its sister vaso- 
motor centre has permitted by finding that its blood-supply is insuf- 
ficient. As respiration falls first, it should be watched first. Finally, 
it is only by watching the respiration that we can tell how much 
chloroform the patient is getting. We do not watch this function for 
danger alone, but to tell us of the dose. 

The answer to Question 3 is that death is always due in the healthy 
animal to respiratory failure accompanied by circulatory depression, 
which latter may be severe enough to cause death, even if artificial 
respiration is used skilfully. Death only occurs in the healthy ani- 
mal when chloroform is given in excessive quantities. 

Question 4 is impossible to answer for man from the basis of 
experimentation, as we cannot produce identical diseased states in 
animals with those developed under various conditions in man. The 
physician having a case of heart disease should always advise the 
patient of the danger of any anaesthetic, and he should remember, 
whether it is wise to tell the patient or not, that anaesthesia always 
means a step toward death, even in the healthiest of men. In the 
event of a death under chloroform the physician is not to blame if he 
has taken proper preliminary precautions and given the chloroform 
properly. 

Every one is agreed that the patient taking chloroform should 
have plenty of fresh air, and in India we understand that, to all 
intents and purposes, patients are operated on in the open air, at 
least as compared to the closed rooms necessary in America and 
Europe. This free supply of air is important, whether we believe 
death to be imminent from cardiac or respiratory failure ; but this 
supply of air matters little to the patient if he does not breathe 
freely, nor does the dose of chloroform amount to aught if it is not 
drawn into the chest. The dose of chloroform is not the amount 
on the inhaler, but the amount taken into the chest, and, finally, the 
amount absorbed by the blood-vessels. The rapidity and depth of 
respiratory movements is, therefore, as Lawrie asserts, the entire key 



CHLOROFORM. 143 

to the situation. We withdraw chloroform, as Lawrie says, whenever 
respiration becomes disturbed in rhythm or when struggling disturbs 
it, because it is the first indication that the drug's action is uncertain, 
and because there is no telling the dose which is absorbed. While 
watching, the respiration will not warn us of a sudden cardiac arrest 
in fatty heart plus chloroform depression, neither will the pulse give 
us such warning; and we are confident that the statement of the 
Hyderabad Commisssion, that the respiration should be watched, is 
correct, for we believe, from a long series of observations, that grad- 
ual cardiac failure never occurs without producing respiratory changes 
from the very first. In other words, we do not believe that in a 
healthy heart chloroform can cause serious disorder without, as a 
result of beginning disorder, disturbing respiration ; and, second, 
that in a healthy heart a quantity of chloroform sufficient to disorder 
it will by its direct action disorder the respiration. If, as an extra 
precaution, one assistant watches the pulse while the other watches 
the respiration, very well, for though the respiration is the more 
important function to watch, the man watching the pulse might dis- 
cover an irregularity which the anaesthetizer may not see reproduced 
in the respiratory action ; but as divided attention generally means a 
slighting of both objects in view, Lawrie is right in insisting on the 
pulse being let alone. 

To Question 5 we have several answers to make : 

1. Chloroform may be used in hot climates (where ether is inap- 
plicable), where a free circulation of air increases the safety of the 
patient. 

2. Chloroform may be used whenever a large number of persons 
are to be rapidly anaesthetized, so that the surgeon may pass on to 
others and save a majority of lives, even if the drug endangers a few, 
as on the battle-field, where only a small bulk of anaesthetics can be 
carried. 

3. Its employment is indicated in cases of Bright's disease requir- 
ing the surgeon's attention, owing to the fact that anaesthesia may be 
obtained with so little chloroform that the kidneys are not irritated, 
whereas ether, because of the large quantities necessarily used, would 
irritate these organs. Quantity for quantity, ether is, of course, the 
less irritant of the two. 

4. In cases of aneurism or great atheroma of the blood-vessels, 
where the shock of an operation without anaesthesia would be a greater 
danger than the use of an anaesthetic, chloroform is to be employed, 
since the greater struggles caused by ether and the stimulating effect 
which it has on the circulation and blood-pressure might cause vas- 
cular rupture. 

5. In children or adults who already have bronchitis, or who are 
known to bear ether badly, or, in other words, have an idiosyncrasy 
to that drug, chloroform may be employed. 

6. Persons who struggle violently, and who are robust and strong, 
are in greater danger from the use of chloroform than the sickly and 
weak, probably because the struggles strain the heart and tend to 
dilate its walls. 



144 DRUGS. 

Other indications for the use of chloroform in preference to ether 
are in brain surgery, where ether is apt to produce meningeal conges- 
tion. In performing tracheotomy, if the case is urgent and the ether 
produces respiratory irritation, chloroform may be used with advantage. 
Finally, in operations about the mouth the vapor of chloroform may 
be well employed by passing a soft catheter into the nose and by 
means of a hand-bulb or Junker inhaler disengaging chloroform vapor 
in the tube. 

The safest method of administration is by Lawrie's or Esmarch's 
inhaler, because these provide free circulation of air and do not dis- 
tract the attention of the anaesthetizer from the respiratory movement 
by complicated apparatus. Apparatus much like these, in allowing 
a free amount of air, are the Hyderabad chloroform inhaler or open- 
ended cone, with Krohne's and Seseman's respiration-indicator attach- 
ment. 

The Junker inhaler, even with its modifications, is too compli- 
cated and cumbersome, and while less chloroform is wasted in admin- 
istering the drug, it must be thrown out of the bottle afterward. If 
used at all, it should be used with the increased air-supply and respi- 
ration-indicator of Krohne and Seseman. 

The author agrees so heartily with Lawrie's personal conclusions 
that we print them below : 

1. The chloroform should be given on absorbent cotton, stitched 
in an open cone or cap. (A depression made through the opening 
in the inside flannel bag will answer as well.) 

2. To ensure regular breathing, the patient, lying down, with 
everything loose about the neck, heart, and abdomen, should be made 
to blow into the cone, held at a little distance from the face. The 
right distance throughout the inhalation is the nearest which does not 
cause struggling or choking or holding of the breath. Provided no 
choking or holding of the breath occurs, the cap should gradually 
be brought nearer to, and eventually may be held close over, the 
mouth and nose as insensibility deepens. 

3. The administrator's sole object while producing anaesthesia is 
to keep the breathing regular. As long as the breathing is regular 
and the patient is not compelled to gasp in chloroform at an abnormal 
rate, there is absolutely no danger whatever in pushing the anaesthetic 
till full anaesthesia is produced. 

4. Irregularity of the breathing is generally caused by insufficient 
air, which makes the patient struggle or choke or hold his breath. 
There is little or no tendency to either of these untoward events if 
sufficient air is given with the chloroform. If they do occur, the cap 
must be removed, and the patient must be allowed to take a breath 
of fresh air before the administration is proceeded with. 

5. Full anaesthesia is estimated by insensitiveness of the cornea. 
It is also indicated by stertorous breathing or by complete relaxation 
of the muscles. Directly the cornea becomes insensitive or the breath- 
ing becomes stertorous the inhalation should be stopped. The breath- 
ing may become stertorous while the cornea is still sensitive. The 
rule to stop the inhalation should, notwithstanding, be rigidly enforced, 



CHLOROFORM. 145 

and it will be found that the cornea always becomes insensitive within 
a few seconds afterward. 

Above all things, it is necessary to remember the fact that a per- 
son having taken chloroform twenty times before does not show he is 
not in danger on taking it the twenty-first time, and it is also to be 
borne in mind that many of the sudden deaths from chloroform have 
occurred during the first inhalation of the drug, before consciousness 
has been lost, and, therefore, when an accident was least expected. 

When chloroform is given it should be poured drop by drop upon 
a folded napkin or towel, and the cloth should then be held about 
three to six inches from the mouth and nose, so that the vapor may 
be thoroughly mixed with air in the proportion of 95 per cent, of 
air to 5 of vapor. The administration must be gradual, as "push- 
ing " the anaesthetic is dangerous. The quantity of chloroform admin- 
istered can only be imperfectly determined by measuring the amount 
thrown on the "inhaler," for during ordinary breathing one quan- 
tity is taken, and in exaggerated breathing much more is respired. 
Increased respiration should be a signal to withdraw the drug rather 
than to push it. 

Chloroform inhalations have been recommended in excessive cho- 
rea and in puerperal convulsions, and are, of course, of great service 
in the reduction of hernia, owing to the muscular relaxation pro- 
duced. Sometimes a few whiffs will put a nervous patient to sleep. 
Parturient women seem able to take chloroform with more safety than 
other women. There are four important factors in increasing the 
safety of chloroform in this class of cases : 1st. Less chloroform is 
given than usual in surgical operations ; 2d. The pregnancy may pro- 
duce immunity by reason of the slight cardiac hypertrophy produced 
at this time ; 3d. The absence of fright, for the woman welcomes the 
anaesthetic ; and 4th. The frequently recurring pains of labor so 
stimulate the vasomotor centre that the dominant action of chloro- 
form — namely, vasomotor depression — is combated. 

Chloroform, when taken internally by the mouth, causes a sensa- 
tion of warmth in the stomach and a hot, burning taste about the lips 
and buccal mucous membrane. In overdose it can and has produced 
death when taken in this manner. Although rarely used in internal 
medicine, chloroform in the form of the spirit of chloroform (Spiritus 
Chloroformi, U. S.) or water of chloroform (Aqua Chloroformi, 
U. S.) is useful in cough mixtures, which are given to persons hav- 
ing an irritative cough, and in cases where, through nervousness or 
other cause, tickling in the throat or bronchial tubes keeps the 
patient continually in a state of unrest. (See Bronchitis.) 

In severe whooping cough a few drops of chloroform may be 
poured on the hand of the attendant and held before the child's face. 
While the child may at first dislike the odor of the drug, the relief 
given soon teaches the patient its value, and he will ask for it when 
he feels the attacks coming on. If the attack is prolonged and vio- 
lent, this may be a dangerous treatment, owing to the strained condi- 
tion of the heart-muscle. 

In gastric or intestinal flatulence 1 or 2 drops (0.06-0.10) of pure 

10 



146 DRUGS. 

chloroform, or 10 to 20 drops (0.65-1.30) of the spirit of chloroform, 
will often give relief. The following prescription is very useful in 
all forms of abdominal pain and is harmless in ordinary dose : 

R .—Spt. chloroformi f^ss (16.0). 

Spt. camphorse f^ij (8.0). 

Spt. lavendul. comp q. s. f ^iij (96.0). — M. 

S. — Dessertspoonful (8.0) every twenty minutes for 4 doses. 

In the treatment of serous diarrhoea when combined with astrin- 
gents and opium the spirit of chloroform is most useful, provided that 
the irritating cause is first removed. In renal or hepatic colic a few 
inhalations, not sufficient to disturb consciousness, will not only give 
temporary but sometimes permanent relief. Hypodermic injections 
of 10 to 15 drops (0.65-1.0), reaching down to a painful sciatic nerve, 
have been recommended by Bartholow. Rubbed on the chest in the 
form of chloroform liniment, this drug will sometimes prevent asth- 
matic attacks, but it ought to be most carefully inhaled in this dis- 
ease, because of the strained condition of the right side of the heart. 
In drachm (4.0) doses chloroform has been used as a remedy for tape- 
worm, but ought never to be so employed. 

When placed in liniments of a stimulating character chloroform 
is a very useful application over muscles affected by soreness and 
stiffness, as in lumbago and gout, and these liniments may also be 
used in neuralgias for their local anaesthetic effect. 

Administration. — The official preparations of chloroform are a lini- 
ment (Linimentum Chloroformi, U. S. and B. P.) ; a water {Aqua 
Chloroformi, U. S. and B. P.), dose J to 2 ounces (15.0-60.0); a 
spirit (Spiritus Chloroformi, U. S. and B. P.), the dose of which is 
20 minims to 1 fluidrachm (1.3-4.0); and an emulsion {Emulsum 
Chloroformi, U. S.), composed of chloroform, gum tragacanth, oil of 
almonds, and water, given in the dose of 2 to 4 fluidrachms (8.0- 
15.0). The B. P. recognizes, besides those given, the following 
preparations : Tinctura Chloroformi Composita, composed of rectified 
spirit, chloroform, and cardamoms, dose 20 to 60 minims (1.3-4.0), 
and Tinctura Chloroformi et Morphinw, dose 5 to 10 minims (0.3- 
0.65). 

CHROMIC ACID. 

Chromic Acid (Acidum Chromicum, U. S. and B. P.) is not a 
true acid, but an anhydride, and occurs in the form of brilliant red 
crystals, which are deliquescent and possess a sour, metallic taste. 
The acid should be kept in glass-stoppered bottles. It should never 
be mixed with sweet spirit of nitre, strong alcohol, or glycerin, or 
any organic matter, as under these circumstances it may explode. 

Therapeutics. — Chromic acid is used solely as a caustic for the 
removal and destruction of growths on the skin or mucous membranes. 
The liquid resulting from its deliquescence on exposure to the air 
may be employed by means of a glass rod if a very severe action is 
needed. The surrounding tissues should always be protected by lard 
or adhesive strips. 



CIMICIFUGA. 147 

Dr. J. Wm. White has recorded a death from the application of 
this acid to a large number of condylomata about the buttocks and 
vulva. Where the drug has been swallowed the patient should be 
treated for gastro-enteritis, and dilute alkalies and lime-water be used, 
as well as emetics and demulcent drinks. 

If a superficial action is desired, a solution containing 100 grains 
to the ounce (6.5 : 32.0) of water is sufficient, and for small warts and 
similar growths this solution will be found strong enough. 

Liquor Acidi Ghromici, B. P,, is composed of 1 part of acid to 3 
of water. 

CHRYSAROBIN. 

Chrysarobin (Chrysarobinum, U. S. and B. P.) is a mixture of 
the proximate principles derived from a powder found in the wood of 
the tree Andira Araroba, which was originally used for medicinal 
purposes in Brazil. In the East Indies it is called " Goa powder." 
Chrysarobin is sometimes misnamed chrysophanic acid, and is a yel- 
low, tasteless powder, soluble in solutions of alkalies, in acids, and 
in ether. 

Therapeutics. — Chrysarobin is given internally in the dose of -J- of 
a grain (0.008) in pso?"iasis and parasitic diseases of the skin, but 
more commonly is employed externally in the form of the official 
ointment ( Unguentum Chrysarobini, U. S. and B. P.), which is too 
strong for direct use, and should be mixed with 4 or 5 parts of ben- 
zoated lard before application to the skin. Even when so diluted 
chrysarobin may cause great swelling and inflammation of the skin, 
with desquamation of the cuticle. Should the surface be broken, it 
may be absorbed and cause vomiting. As the drug stains the skin 
a dark-brown, it ought not to be used on the face, although the dis- 
coloration may be removed by a weak solution of chlorinated lime. 
In psoriasis the following may be employed : 

R. — Chrysarobini ^j (4.0). 

Alcoholis} aaq.s.adft.sol. 

Collodii f^ij (64.0).— M. 

S. — Apply to the part affected with a brush, after a bath. 



CIMICIFUGA. 

Cimicifuga ( TJ. S.). — This drug is derived from Cimicifuga Race- 
mosa, otherwise known as black cohosh or black snake-root. It con- 
tains a resin and a volatile oil, upon which its medicinal powers are 
supposed to depend. The fluid extract and tincture should always be 
freshly prepared from the fresh crude drug. It is official in the B. P. 
as Cimicifuga? Rhizoma. 

Physiological Action. — In large doses cimicifuga paralyzes the sen- 
sory side of the spinal cord, and in consequence lowers reflex activity. 
It has no effect on the nerves and muscles. On the circulation the 
drug acts by depressing the heart and vasomotor system. Death is 



148 DRUGS. 

due to respiratory arrest. In small dose it is a cardiac stimulant. In 
overdose it nearly always produces frontal headache. 

Therapeutics. — Cimicifuga is, after arsenic, the best remedy we 
have for chorea, particularly if the patient is otherwise in good 
health, but it should be used with careful attention to the bowels and 
often be accompanied by iron. It is also indicated where there is, 
in addition to St. Vitus's dance, a rheumatic tendency. In chronic 
bronchitis it is asserted to be of value, and in rheumatism of a sub- 
acute or chronic type cimicifuga sometimes gives relief. 

Cimicifuga has been highly praised in the treatment of neuralgia, 
particularly of the ovarian type, and in amenorrhosa, subinvolution, 
and tenderness of the womb. To women who state that thev cannot 
step off a step without paining or hurting the uterus or ovaries cimi- 
cifuga often gives relief. Some writers assert that it is an efficient 
and active heart tonic in cases of fatty and irritable heart when 
digitalis fails. There can be no doubt that it is a powerful uterine 
stimulant, and it ought not to be used during pregnancy for fear of 
abortion. By reason of this power it may be employed instead of 
ergot during labor, and is better in some cases, because it produces 
normal not tonic contractions. In the treatment of headache arising 
from overstraining of the eyes in study cimicifuga is said to do good. 

The drug is official in the form of the extract (Krtractum Cimi- 
cifuga?, TJ. S.), dose 1-5 grains (0.05-0.3), the fluid extract (Extr ac- 
tum Cimicifuga? Fluidum, TJ. S. and B. P.), the dose of which is 10 
to 30 drops (0.65-2.0) or even 1 drachm (4.0), and the tincture {Tinc- 
tura Cimicifugce, TJ. S. and B. P.), the dose of which is 1 to 2 
drachms (4.0-8.0). 

CINCHONA. 

Cinchona, TJ. S., is a name applied to the bark of all the trees 
belonging to the genus Cinchona, provided they contain as much as 
5 per cent, of the alkaloid quinine. The same barks are included 
under the name of Cinchona Cortex in the B. P. There are thirty- 
one species of this genus, but only a comparatively small number can 
be included in the list of 5 per cent, of obtainable alkaloid. These 
are the Cinchona Calisaya, or Cinchona Flava, which contains the 
most quinine, the Cinchona Condaminea, Cinchona Micrantha, Cin- 
chona Succiruba, or Cinchona Rubra, TJ. S., Cinchona Rubra Cortex, 
B. P., and Cinchona Pitayensis. The first is called yellow bark, the 
second pale bark, the fourth red bark. The alkaloids of the quinine 
series derived from these barks are quinine or quinina, quinidine cr 
quinidina, and quinicine, which is an artificial alkaloid. Of the cin- 
chonine series we have cinchonine {Cinchonina, TJ. S.), and its sul- 
phate {Cinchonince Sulphas), cinchonidine (Cinchonidina* Sulphas, 
TJ. S. and B. P.), and cinchonicine, which last is also an artificial 
alkaloid. Besides these alkaloids we have present kinic and kinovic 
acids and other inert and useless substances. 

As quinine is the most important of the group, and as its physio- 
logical action is virtually identical with the rest, whatever is said 



CINCHONA. 149 

hereafter in this article refers to quinine, unless it is otherwise 
stated. 

Physiological Action. — When quinine is taken in overdose it causes 
ringing in the ears, dizziness, disorders of taste and smell, disturbance 
of vision in some cases, and fulness in the head. Deafness often comes 
on, and is generally, with the roaring in the ears, the most pressing 
symptom. Headache is not uncommon. 

Xeryous System. — Upon the cerebrum quinine acts as a stim- 
ulant, and finally as a congestant, if given in excessive dose. If poi- 
sonous doses are used, intense cerebral congestion ensues, and finally 
unconsciousness comes on. On the spinal cord the drug first causes 
a decrease in reflex action by stimulating Setschenow's reflex inhib- 
itory centre, and finally by depressing the spinal cord and nerves. 
The latter changes occur only after poisonous doses. 

Circulation. — If quinine, even in small amount, be injected into 
the jugular vein of a dog, so that it goes in concentrated form to the 
heart, cardiac paralysis will result. If this does not occur, the drug 
decreases pulse-force, pulse-rate, and arterial pressure. In minute 
doses the drug acts as a general stimulant to the entire body, and so 
supports the circulation. 

Blood. — The blood after poisonous doses is more coagulable than 
normal, but in medicinal amounts no such effect is produced. The 
movement of the white blood-cells through the walls of the capillaries 
in inflamed areas is checked by large doses of quinine, and medicinal 
amounts increase the number of the red blood-corpuscles very mate- 
rially. It is said that quinine prevents the oxygen-bearing powers of 
the corpuscles, but this probably does not occur from medicinal doses. 

Respiration. — Upon respiration quinine acts as a slight stimulant 
in small doses, but as a marked depressant in poisonous amounts, 
death being most commonly due to failure of respiration if it be taken 
by the stomach in lethal dose. 

Temperature. — Quinine lowers bodily temperature in health very 
little if at all, and in fevered states its influence is governed by the 
cause of the fever. Thus in malarial fevers quinine is a very power- 
ful antipyretic. 

In fever before crisis quinine is of little service, but in that after 
crisis it causes a rapid fall. 

As an antiseptic quinine has considerable power. 

Quinine is absorbed from the stomach, not from the intestine, and 
it is precipitated by the alkaline juices of the bowel. 

Kidneys, Elimination, and Tissue-waste. — Quinine escapes 
from the body chiefly through the kidneys, although much of it is 
destroyed by oxidation in the liver and tissues. The process of 
excretion of quinine is by no means rapid, so far as the entire quan- 
tity to be eliminated is concerned. While it may in rare instances 
be found in the urine in fifteen minutes from the time it is given, it 
does not disappear from this secretion for about twenty -four hours. 
In the urine it is found as quinine and as dihydroxyl quinine. 

Upon tissue-waste quinine acts as a depressant and decreases the 
elimination of nitrogenous materials. 



150 DRUGS. 

Poisoning and Untoward Effects. — Severe poisoning so seldom occurs- 
as the result of the ingestion of overdoses of quinine that untoward 
effects is the best term with which to qualify the disagreeable symp- 
toms which sometimes come on in persons having an idiosyncrasy to 
the drug and who are in reality poisoned by small doses. In these 
cases sudden, complete, but temporary blindness is often met with. 
De Schweinitz has shown that in dogs quinine produces in toxic doses 
permanent optic atrophy and thrombosis of the central vein of the 
retina. He believes that the drug produces local changes in the ves- 
sels of the eye (endo-vasculitis). In other instances complete deaf- 
ness asserts itself, due to congestion of the middle ear, while skin 
eruptions, generally of the nature of erythema, are not rarely seen. 
After lethal doses hemorrhage into the middle ear may be found, and 
severe epistaxis may ensue after so small a dose as 4 grains (0.2). 
The buzzing in the ears can generally be put aside by 10 grains (0.65) 
of bromide of sodium with a little ergot. Karamitsas has proved 
that quinine may produce hsemaglobinuria in persons suffering from 
malarial poisoning, and apparently may even develop bilious remit- 
tent fever. Irritability about the neck of the bladder may sometimes 
be produced by quinine. 

Therapeutics. — This drug is employed in medicine to fulfil four great 
offices, although its influence in other directions is hardly less powerful. 
These are as an antiperiodie or antimalarial, as an antipyretic, as a tonic 
possessing peculiar virtues, and as a stimulant to the parturient uterus. 

For many years physicians were forced to employ this drug empiri- 
cally, not knowing the cause of the disease process called malaria. 
We now know that the theory of Binz, offered as long ago as 1867, is- 
correct, and that malaria is due to the presence of a germ, the Plas- 
modium malarias, which was first accurately studied by Laveran and 
named by Marchiafava and Celli. These and other investigators have 
found that quinine acts as an active poison to these germs, even in so 
weak a solution as 1 : 20,000. 

For the reasons given in the preceding paragraph quinine is the 
best remedy we have for malarial fever as a prophylactic and cure, 
and it should be given in doses which are indicated by the state of 
the patient. (See Malarial Fever.) It should always be preceded by 
a purge having an hepatic action, if this is possible. This fact is par- 
ticularly important in bilious or remittent fever. The drug should be 
given in hourly doses, or in one or two large doses in such a way that 
its influence is fully felt, not at the time of the expected paroxysm, 
but about an hour or thirty minutes before that time. If the parox- 
ysm is near at hand, the drug should be given in solution, bitter 
though it be, in acidulated water. 

As a prophylactic against malaria the dose of quinine should be 2 
to 4 grains (0.1-0.2) or more three times a day. 

In malarial cachexia or hemorrhagic malarial fever quinine gen- 
erally does more harm than good. Under such circumstances the 
danger in using quinine consists in irritating the engorged kidneys 
after the chill has passed by. The quinine is not a hemostatic, and 
only does good in malarial hematuria by preventing the paroxysm 



CINCHONA. 151 

which will produce the bloody urine. To give quinine after this 
svmptom appears is to "lock the door after the horse is stolen." In 
hematuria occurring from chronic malarial poisoning without a chill 
quinine is of no value. 1 

In pernicious malarial fever quinine should be given by the mouth, 
by the rectum, and hypodermically, as much as 60 to 70 grains (4.0- 
4.5) being used at a dose. In brow ague or malarial neuralgia qui- 
nine often acts most usefully, and this is also true in some cases of 
ordinary nerve-pain not dependent upon a specific disease. 

For the reduction of the pyrexia of typhus or typhoid fever qui- 
nine will be found inferior to the new antipyretics, even when given 
in very large dose, and ought to be used very rarely. It will seldom 
cause a fall of temperature before crisis or lysis, but will aid in the 
fall very actively after these changes have occurred. 

As a tonic quinine is not only a simple bitter, but also seems to 
have a direct effect in increasing the number of the red blood-corpus- 
cles. The tonic dose should be 1 to 2 grains (0.05-0.1) three times 
a day. 

In parturient women the drug undoubtedly aids in the expulsion 
of the child by stimulating the uterine contractions, either by a direct 
influence over the uterus or by supporting the system. Its use is 
particularly indicated in cases where the pains have ceased because 
of exhaustion from prolonged labor. The dose should be 10 to 20 
grains (0.65-1.3) dissolved in water in order that immediate absorp- 
tion may occur. Quinine will not of itself cause abortion. 

In the lobar pneumonia of children quinine should be used in sup- 
positories in the dose of 2 grains (0.1) three times a day. 

Acting on the basis that chorea is clue to lack of inhibitory con- 
trol of muscular movements, Wood has urged the use of quinine in 
large doses in this disease as a stimulant to inhibition. Whether the 
good which sometimes follows this treatment is due to any specific 
effect of the drug is doubtful. 

In cases where prolonged mental or physical strain is to be under- 
gone, quinine in the dose of 2 to 4 grains (0.1-0.2) will often prevent 
exhaustion and support the system. 

Used in solution in the form of a spray by the atomizer, quinine 
is of undoubted service in whooping cough, and will often prevent the 
spread of the disease to other children if they be subjected to its use. 
Its internal use is also a wise procedure in this disease, and the best 
dose, according to a careful series of studies by Baron, is 1J grains 
(0.075) to each year of the child's age, to be given at 6 A. M., 2 
p. m., and 10 p. M. The solution should contain from 1 to 2 grains 
(0.05-0.1) to the ounce (32.0) and be employed every few hours. It 
is well to remember that quinine is not tasted by the tip of the tongue, 
but is tasted by the back portion. The tip of the atomizer should 
therefore be carried well back of the root of this organ, and a 1 per 
cent, solution of cocaine painted over the dorsum of the tongue in 
cases where the disagreeable taste of the quinine is objected to very 

1 See collective investigation of this subject by the author in Therapeutic Gazette 
for July, 1892. 



152 DRUGS. 

strongly. This solution of quinine used, by means of an atomizer, in 
colds in the head and in foetid sore throat is often of service. Quinine 
injections in the strength of 1 to 3000 are useful in amoebic dysentery, 
as this drug destroys the amoeba coli. 

A very much more agreeable method of pursuing this treatment 
in whooping cough is to give the patient the so-called quinine choco- 
lates, which are made of 1 grain (0.05) of tannate of quinine and 
chocolate. They do not taste of quinine at all if well made. 

Administration. — Quinine ought never to be given in solution if 
it can be avoided, because of its disagreeable taste. In adults and 
children it should be used preferably in small capsules and in pills, 
w T hich may be gelatin- or sugar-coated. Care should be taken that 
the gelatin is thin and the sugar not hardened by age, for if the pill 
escapes into the intestine the quinine is precipitated and not absorbed. 
If the case is that of a child too young to take a pill, the drug may 
be given in the following manner without tasting very disagreeably : 

R. — Quininse sulph gr. xvj (1.0). 

Ext. glycyrrhiz. fl f£j (4.0). 

Syrup i aurantii cort. vel syrupi zingi- 
bers vel yerba santi f^ij (64.0). — M. 

S. — A teaspoonful t. d. for a child of three years. ■ • ■ 

In some cases quinine chocolates may be used, but unless they are 
w T ell made the after-taste of quinine is well marked. When they are 
used the tannate of quinine should always be placed in them. In 
other cases quinine may be used in the suppository in the dose of 2 
to 3 grains (0.1-0.15), care being taken that irritation of the rectum 
does not ensue. 

For hypodermic use the bisulphate of quinine (Quinince Bisulphas, 
U. S. and B. P.) should be used most commonly, as it is soluble in 
about 8 parts of water. To its solution should be added a little tar- 
taric or sulphuric acid to prevent precipitation of the drug in the 
alkaline juices of the connective tissues before it can be absorbed. 
The tartaric acid should be present in the proportion of about 1 grain 
(0.05) to each 5 grains (0.3) of the quinine. If sulphuric acid is 
employed, 10 grains (0.65) of the sulphate of quinine should be added 
to a drachm (4.0) of water and the acid added, drop by drop, until 
the salt is dissolved. The hydrobromate of quinine (Quinince Hydro- 
bromas, U. S.), the solubility of which is about 1 to 16 of water, may 
also be used hypodermically, as may also the bimuriate of quinine and 
urea (Quinince Bimuriatica Oarbamas), w T hich, however, is scarcely 
more than half as strong in quinine as the other salts. The hydro- 
chlorate of quinine is also a useful salt for hypodermic use, and is the 
strongest in alkaloid. It may be employed in the following manner : 

R .— Quininse hydrochlorat gr. vij (0.5). 

Glycerin! j -- f ( 2 .0).-M. 

Aqua? dest. J . 

S. — Warm solution before using it, and do not add acid. 

R. — Quininse hydrochlorat gr. xv (1.0). 

Alcoholis • n\,xv(1.0). 

Aqua? dest f^jss (6.0).— M. 

S. — Add a few drops of hydrochloric acid to complete the solution before using. 



CINCHONA. 153 

The best place to give the hypodermic injection is in the buttock, 
between the trochanter and the tuberosity of the ischium. Injections 
into the calf of the leg are very painful. 

In Italy, Baccelli has resorted to the intravenous injection of qui- 
nine in pressing cases. He employs the following solution for this 
purpose : 

R. — Quininse hvdrochlorat gr. xv (1.0). 

Sodii chloridi < gr. xij (1.0). 

Aquas dest .• • • f^ijss (10.0).— M. 

S. — This should be injected, after distilled water is added to it, into a vein of the leg 
rather than into a vein of the arm, to avoid too great an effect on the heart, and 
the solution should be boiled and filtered before using, and used while warm. 

As quinine in concentrated form is a powerful heart depressant, 
the injection should be given very slowly indeed when intravenous 
methods are employed. 

Valerianate of quinine (Quinines Valerianas, U, S.) is given in 
1- to 2-grain (0.05-0.1) doses, and the hydrochlorate (Quinince Hydro- 
chloras, TJ. S. and B. P.) in the dose of 1 to 10 grains (0.05-0.65). 
The alkaloids of cinchona other than quinine which are commonly 
used in medicine are cinchonidine, cinchonine, quinidine, and chinoi- 
dinum. Cullen, Sinkler, and De Brun have all found the sulphate of 
cinchonidine very useful in malaria, and it is less bitter and more sol- 
uble than is quinine. Sinkler states that it does not produce the 
severe head symptoms caused by quinine. 

The dose of quinidine sulphate (Quinidinoe Sulphas, TJ. S.) is 
about twice that of quinine, as is also that of cinchonine sulphate 
(Cinchonince Sulphas, TJ. S. and B. P.) and cinchonidine sulphate 
(Cinchonidina Sulphas, TJ. S. and B. P.). The tannate of quinine 
is a salt not so bitter as the other salts and is weaker in relative alka- 
loidal strength. 1 grain (0.05) of the tannate equals about J of a 
grain (0.015) of pure alkaloid. The bisulphate equals about two- 
thirds and the sulphate three-quarters of a grain of the pure alkaloid. 

Chinoidinum is a resinous mass obtained in the preparation of the 
alkaloids of cinchona, and contains amorphous alkaloids. It possesses 
distinct antiperiodic power, and may be used freely where cost is a 
matter of importance. Its dose is three or four times that of quinine. 

The liquid preparations of cinchona are the infusion (Infusum 
Cinchonce, TJ, S.), dose a wineglassful (32.0); the tincture (Tinctura 
Cinchona*, TJ. S. and B. P.), one or two teaspoonfuls (4.0-8.0) ; and 
the compound tincture (Tinetura Cinchona? Composita, TJ. S. and 
B. P.), a teaspoonful to a tablespoonful (4,0-16,0). Under the name 
of elixir roborans, or Whytt's tincture, a similar mixture is employed 
for precisely the same purposes. Huxham's tincture is a most efficient 
and elegant bitter tonic in debility and convalescence from low fevers. 
It is too weak to be used in malarial poisoning. The other liquid 
preparation is the fluid extract (Extractum Cinchonce Fluidum, TJ. S. 
and B. P.), dose 5 to 15 drops (0.3-1.0). A solid extract (Extractum 
Cinchona?, TJ. S.) is also official in the dose of 5 to 10 grains (0.3-0.65). 
The B. P. preparations not official in the TJ. S. P. are as follows : 
Decoctum Cinchonce, dose 1 to 2 fluidounces (32.0-64.0) ; Infusum 



154 DRUGS. 

Cinchonce Acidum, dose 1 to 2 fluidounces ; Tinctura Quinince Ammo- 
niata, dose \ to 2 fluidrachms (2.0-8.0) ; Vinum Quinince, dose \ to 
1 fluidounce (16.0-32.0). 

Contraindications. — Quinine is contraindicated in gastritis, cystitis, 
meningitis, epilepsy, cerebritis, middle-ear disease, and in those cases 
which have an idiosyncrasy to its action. 



CINNAMON. 

Cinnamon {Cinnamomum Cassia vel Saigonicum vel Zeylanicum, 
U. S., Cinnamomum Cortex. B. P.) is the inner bark of a plant, a 
native of Ceylon or of the species indigenous to China. It contains 
a volatile oil and tannic acid. In overdose the oil acts as a soporific 
and kills by failure of respiration. 

Therapeutics. — Cinnamon is used, as are all the drugs of its class, 
for flavoring, as a carminative, and as an intestinal stimulant in serous 
diarrhoeas. It has the peculiar power of acting as a haemostatic in 
uterine hemorrhage where the flow is oozing and not active, thereby 
differing from the other volatile oils, with the exception of that of 
erigeron. The oil of cinnamon is a powerful antiseptic, which can 
be used in dilute form in the dressing of wounds and by injection in 
gonorrhoea. J. Chalmers DaCosta employs a spray of oil of cinna- 
mon and benzoinol in the proportion of 1, 2, or 3 drops (0.05-0.15) 
of the oil to 1 ounce (32.0) of benzoinol, or it may be used by injec- 
tion. It seems to act best in the early stage. 

Cinnamic acid, a derivative of oil of cinnamon, is also used for 
the same purposes. 

Administration. — The dose of the oil {Oleum Cinnamomi, U. S. 
and B. P.) is 1 to 5 drops (0.06-0.3) ; of the water {Aqua Cinna- 
momi, U. S. and B. P.), a wineglassful (32.0) or less; of the spirit 
{Spiritus Cinnamomi, U. S. and B. P.), 5 to 30 drops (0.3-2.0); 
of the tincture {Tinctura Cinnamomu U. S. and B. P.), \ to 1 drachm. 
Under the name of Pulvis Aromaticus, U. S. {Pulvis Cinnamomi 
Compositus, B. P.) a carminative powder, consisting of cinnamon 
35 grams, nutmegs 15 grams, cardamoms 15 grams, and ginger 35 
grams, is official. It is useful in the treatment of the flatulence of 
adults and children. The latter should take about 10 grains (0.7) at 
a dose, an adult 30 grains (2.0). 



CITRATE OP POTASSIUM. 

Citrate of Potassium {Potassii Citras, U. S. and B. P.) is a white, 
granular, deliquescent salt, almost neutral in reaction and very solu- 
ble in water. It is by far the most agreeable of all the salts of potas- 
sium to the taste. In the early stages of bronchitis it is of the greatest 
value when combined with ipecac (see Bronchitis), and it is also use- 
ful as an alkaline diuretic. In bronchitis the dose should be 20 grains 
(1.4) every four hours, and in urinary incontinence due to acid and 
concentrated urine the dose should be equally large. 



CITRIC ACID. 155 

Under the name of neutral mixture (Mistura Potassii Citratis), 
made by adding to 1 pint (-J litre) of lemon-juice enough bicarbonate 
of potassium to neutralize it, we have a useful febrifuge drink in 
fevers, particularly those of childhood. The dose is \ to 1 ounce 
(16.0-32.0) every few hours. 

Liquor Potassii Citratis, U. S., is made in the same manner as is 
tbe neutral mixture, except that citric acid is substituted for the 
lemon-juice (citric acid 6 grm., potassium bicarbonate 8 grm., and 
water 100 cc). 

Neutral mixture is the better preparation of the two, but more 
expensive. A very refreshing and agreeable way of prescribing this 
drug is in the form of " effervescing draught," made by mixing two 
solutions which are prepared as follows : 1. Lemon-juice and water, 
equal parts, enough to make 4 ounces (128 gm.). 2. Bicarbonate of 
potassium 1 drachm (4.0) and water 3 ounces (96.0). These solutions 
are to be mixed in the quantities desired, and taken while efferves- 
cing. If lemon-juice is not at hand, a solution of citric acid of the 
strength of 2 drachms (8.0) to 4 ounces (128.0) of water should be 
employed in its stead. 

Under the name of Potassii Citras Effervescens the U. S. P. of 
1890 calls for an official powder possessing the advantages of the 
mixture just named. 

CITRIC ACID. 

Citric Acid (Acidum Citricum, TJ. S. and B. P.) is chemically iden- 
tical with the acid of the lemon, but has not identical influences over 
the body with lemon-juice. 

Not only does the lemon owe its acidity to this acid, but most of 
the other edible fruits, such as strawberries and raspberries, depend 
upon its presence for their acidity. 

Therapeutics. — Citric acid is used in scurvy, or scorbutus, as a pro- 
phylactic and cure. For some unknown reason, pure lemon-juice 
seems to benefit these cases more than citric acid itself, and it is there- 
fore to be preferred to the latter whenever it can be had. In order 
to keep lemon-juice from decomposition on long voyages, it should be 
boiled, and poured while hot into bottles until it nearly reaches to the 
cork ; the remaining space is then filled with a thin layer of sweet oil 
and the bottle corked and stood upright. Under these circumstances 
the juice may be kept indefinitely. 

In some cases lemon-juice or lemonade will cause indigestion and 
a sensation of weight in the stomach ; particularly is this the case with 
the sick. This is due to the presence of soluble irritant albuminoids, 
which should be precipitated by boiling the lemonade, decanting the 
solution on cooling, and leaving the precipitate to be thrown away. 
If the supernatant liquid is cooled and properly sweetened, it is almost 
as agreeable as the fresh juice and devoid of irritant power. 

In rheumatism, either acute or chronic, lemon-juice may be em- 
ployed in the dose of 1 to 2 ounces (32,0-64.0) four times a day, well 
diluted, or 2 drachms (8.0) of citric acid may be given. The acid is 



156 DRUGS. 

also of value in hepatic inactivity and catarrhal jaundice. (See Citrate 
of Potassium.) 

The preparations containing citric acid are Syrwpus Acidi Citrici, 
U. S., Succus Limonis, B. P., and Syrwpus Limonis, B. P. 



CLOVES. 

Cloves (Caryophyttus, U. S. ; Carophyllum, B. P.) are the unex- 
panded flowers of the Eugenia Aromatica, a plant of the East and 
West Indies. They possess an aromatic odor and the pungent taste 
of a typical spice. They contain a volatile oil {Oleum Carophylli, 
U. S. and B. P.), which is yellow when fresh, but very dark-colored 
when old. 

Therapeutics. — Cloves or their oil are used in medicine for the 
purpose of acting as a carminative. They are also employed as a 
stimulant and tonic to the stomach to prevent griping during an 
attack of diarrhoea, or that caused by purgatives, to act as a flavor- 
ing agent, as a counter-irritant, and, finally, as a parasiticide and 
local ancesthetic. 

Like all volatile oils, this oil is an efficient local application for 
pediculis pubis and similar parasites, and it may be used in toothache, 
because of its anaesthetic powers, if placed on a pledget of cotton in 
the cavity of a tooth. In the treatment of myalgia or muscular rheu- 
matism oil of cloves is often placed in the liniment for its counter- 
irritant effect. In overdose it acts as a soporific, and kills by failure 
of respiration and the production of marked gastro-enteritis. Minute 
doses of J to 1 drop (0.03-0.06) of the oil in a little water will some- 
times control excessive vomiting. In addition to the oil the B. P. 
has an official infusion, Infusum Caryophylli, the dose of which is 1 
to 2 fluidounces (32.0-64.0). 



COCA AND COCAINE. 

Erythroxylon Coca is official in the U. S. and B. P. as Coca, but 
in the U. S. P. of 1880 it was known as Erythroxylon. Cocaine 
(Qocaince Hydrochloras, U. S.) is the alkaloid derived from Ery- 
throxylon Coca, a shrub of Peru and Bolivia. A second alkaloid, 
known as ecgonine, has entirely different powers. It is to be dis- 
tinctly understood that Erythroxylon Coca is not the same as choco- 
late, or Theobroma Cacao. 

Physiological Action. — Coca and its alkaloid cocaine, when taken 
internally, produce a sense of exhilaration and pleasure. Often the 
amount of muscular and mental power is temporarily increased under 
their influence. When locally applied to a mucous membrane, cocaine 
causes a blanching followed by marked congestion. 

Nervous System. — The dominant action of cocaine, when locally 
applied, is to paralyze the peripheral sensory nerves. When taken 
internally it stimulates the brain to an extraordinary degree, but 



COCA AND COCAINE. 157 

exercises no effect upon the sensory nerves. Sometimes its internal 
use produces a decrease of sensation which Mosso believes to be due 
to an influence on the spinal cord. This effect is, however, very 
feeble. If the dose be a poisonous one, convulsions of cerebral origin 
ensue, and are both clonic and tetanic in type. 

The sensory nerves are paralyzed by enormous doses both when 
the drug is directly applied and when it is taken internally. 

Upon the muscles, when taken internally, Mosso has proved the 
drug to be a direct stimulant, and it is particularly active after starva- 
tion or fatigue. 

Circulation. — Cocaine acts as a stimulant to the heart and cir- 
culation in moderate amounts, but its effects are not marked except in 
poisonous dose. 

Respiration. — The drug acts as a powerful respiratory stimulant, 
producing in large dose a great increase in the rapidity of the respira- 
tory movements, but in poisonous dose it kills by failure of respira- 
tion associated with exhaustion from convulsions. 

Temperature. — Cocaine raises bodily temperature to a very 
extraordinary degree if given in overdose, this rise being due to an 
increase of heat-production (Reichert). In moderate amounts it has 
no effect. 

Kidneys, Elimination, and Tissue-waste. — The drug is elimi- 
nated by the kidneys, but is chiefly destroyed by oxidation in the 
body. The quantity of urine passed is increased under its influence, 
and the nitrogenous elements eliminated in this fluid are a little 
diminished. 

Eye. — Owing to its powerful action as a local anaesthetic, cocaine 
has been used largely in diseases of the eye. The anaesthesia comes 
on in from one to five minutes after the use of the drug, according to 
the strength of the solution used, and is accompanied by very marked 
dilatation of the pupil, which Koller asserts is due to the fact that 
the drug constricts the blood-vessels of the iris and leaves the mus- 
cular fibres untouched. It is important to remember that this dila- 
tation, unlike that produced by mydriatics, such as atropine, is not 
accompanied by paralysis of accommodation. The drug does not 
cause a forcible mydriasis, and is never used for the prevention of 
adhesions in iritis unless combined with atropine. 

Therapeutics. — Cocaine hyclro.chlorate(CWam#? Hydrochloras, TJ. S. 
and B. P.) is used as an anaesthetic in the eye in the dose of from 3 
to 5 or more drops of a 1 to a 4 per cent, solution. The strength of 
2 and 3 per cent, is perhaps most commonly employed. 

The conditions indicating its use are all operations upon the eye 
of a painful character, be they what they may, and it is also to be 
used for the relief of pain when an acute inflammation or foreign 
body is causing suffering. 

The following formula will be found useful in these states : 

R. — Cocainse hydrochlor gr. viij (0.53). 

Acid, boric gr. vij (0.46). 

Aqua? dest. . . . - ■ f Sj (32.0).— M. 

S. — Use with a dropper in the eye every half hour until relieved. 



158 DRUGS. 

Cases are recorded in which cocaine has caused permanent corneal 
opacities. Cocaine is often used in 2 per cent, solution upon cracked 
nipples just before nursing to relieve pain. The drug must be carefully 
washed off before the baby is put to the breast, Guenel and Desamaux 
assert that this treatment may permanently stop the flow of milk. 

Owing to the density of the mucous membranes of the vagina and 
rectum, cocaine has little effect upon them unless used in 10 per cent, 
solution and profusely applied. In the mouth cocaine may be used 
in cases of stomatitis where a spot is to be cauterized, in pharyngitis, 
and in soreness and tenderness of the gums. While it gives much 
temporary relief in pharyngitis, the subsequent effects are often 
exceedingly disagreeable, the congestion looking more angry and 
being more painful than before, and the experience of the writer 
indicates that it will only act in a curative manner if applied before 
the capillaries become relaxed or paralyzed by the severity of the 
inflammatory process. In coryza and hay fever a powder consisting 
of cocaine, morphine, and bismuth in the proportion of 1 part each 
of the two alkaloids and 5 parts of the bismuth will often be of ser- 
vice if snuffed up into the nostrils. If cocaine be applied to a large 
nerve-trunk, amputation of the tributary limb may be performed with- 
out pain, but so large an amount of the drug must be used that there 
is great danger of poisoning the patient. 

Cocaine is generally used at present in the place of ether in cases 
requiring amputation of the fingers or in cases of minor surgery where 
the drug can be confined to the part injured. A tight cord should 
be bound around the base of the finger and a 4 to 8 per cent, solu- 
tion injected into the part, a ligature about the base of the digit being 
used to prevent hemorrhage and the systemic absorption of the drug. 
After the operation is concluded slight hemorrhage should be allowed 
to occur to sweep out the drug, and thereby avoid systemic medi- 
cation. Not more than \ grain of cocaine should be injected. 

It is worth remembering that cocaine is soluble in fats, whereas 
its salts are not. Cocaine itself should therefore be used in anaes- 
thetic salves. 

Internally, cocaine or the fluid extract of coca may be used as a 
supportive and stimulant in low fevers, and in cases where great 
physical and mental strain is to be borne. Thorington has found 
cocaine of very great value as a stimulant and anti-emetic in yelloiv 
fever. In the vomiting of pregnancy and other forms of excessive 
emesis it is of great service by depressing the gastric sensory nerves 
and thereby decreasing the irritability of the stomach. 

Cocaine is undoubtedly of service in the opium habit, but if 
largely used soon changes the patient from a case of morphiomania 
to a ''coca fiend." 

The dose of the fluid extract (Extractum Coca? Fluidum, U. S. 
and B. P.) is from J to 2 drachms (2.0-8.0); that of cocaine, from 
J to J grain (0.015-0.03). The other B. P. preparation is Lamella? 
Cocaince, each disk containing y^-g- grain (0.0006) of cocaine hydro- 
chlorate. 

A new preparation of cocaine which is said to possess very distinct 



CODEINE. 159 

advantages over those commonly employed is the phenate of cocaine. 
As is well known, carbolic acid exercises, even when used alone, very 
marked anaesthetic powers, and simultaneously coagulates the albumin 
in the tissues with which it comes in contact. One of the dangers in 
the employment of the hydrochlorate of cocaine is its absorption and 
the production of poisoning. The phenate of cocaine is insoluble in 
water, and is therefore very slowly absorbed, and in addition coagu- 
lates the albumin, thereby imprisoning itself. By this means not 
only are the dangers named avoided, but the period of anaesthesia is 
greatly prolonged. As the phenate of cocaine is soluble in alcohol, 
there is generally much pain when it is used hypodermically. The 
manufacturers state that this may be largely avoided by the use of 
the following : 

&. — Cocain. phenat gr. j (0.06). 

Alcoliolis f 3jss (6.0). 

Aqme dest f.^jss (6.0).— M. 

S. — 15 minims (1.0) to be given at each injection. 

Whether phenate of cocaine will prove of much value remains to 
be seen. 

The Cocaine Habit is a condition unfortunately often met with 
since the introduction of the drug into the United States. It is often 
combined with the morphine habit, and sometimes is employed as a 
substitute for that depraved taste. The symptoms of the cocaine 
habit consist of marked loss of flesh, disorders of the circulatory 
system, mental failure and delusions, sometimes resembling those of 
chronic alcoholism. Often hallucinations come on which are generally 
of a disagreeable type. The habit is difficult to cure, for relapses 
are frequent. The sudden withdrawal of cocaine from a patient may 
result in profound collapse. 

Untoward Effects. — Sometimes loss of speech, blindness, nausea 
and vomiting, syncope, and unconsciousness have followed the internal 
use or local application of cocaine. Epileptiform convulsions have 
also been noted, while the circulation and respiration have been dis- 
ordered in every possible manner. In many of these cases the urine 
passed after the poisoning is very limpid and contains albumin. 
Curiously enough, a large number of cases of severe poisoning have 
followed the injection of cocaine into the urethra previous to some 
operation for the relief of chronic gonorrhoea or stricture. 

The treatment of the poisoning consists in the use of ammonia, 
coffee, strychnine, or ether and alcohol if the symptoms are those of 
depression. If they are convulsive in type, then the treatment to be 
instituted is identical with that of strychnine poisoning (which see). 
Out of 250 cases of poisoning so far reported, 13 have been fatal. 



CODEINE. 

Codeina, U. S. and B. P., is an alkaloid prepared from opium, 
and is often contaminated by morphine. The sulphate of codeine is 
often used, as it is more soluble than codeine itself. 



160 DRUGS. 

Physiological Action. — Codeine resembles morphine very decidedly 
in its physiological action, the chief difference being that it possesses 
less narcotizing power, but in large amount more readily produces 
tetanus and final paralysis of the peripheral motor nerves in the lower 
animals (Dott and Stockman). It does not arrest secretion in the 
respiratory and intestinal tract, as does morphine, and therefore 
seldom .produces constipation. 

Therapeutics. — Codeine has been highly recommended in France 
as a nervous quietant, and in this country in nervous cough or in 
cases where the cough is excessive in bronchitis and phthisis. In 
diabetes mellitus some clinicians have found it of the greatest value, 
while others have been disappointed in its use. It should, however, 
always be tried in this disease, in the hope that it may exercise a 
favorable effect. When given for cough it should be used in the 
dose of from l to 2 grains (0.03-0.12), generally placed in the syrup 
of wild-cherry bark. When given for diabetes the dose should be 
much larger, beginning at 3 or 4 grains (0.15-0.2), and rapidly 
increasing it to 20 or 30 grains (1.3-2.0) or more three times daily. 



COD-LIVER OIL. 

Oleum Morrhuce, U. S. andi?. P., sometimes called Oleum Jec oris 
Aselli, is a fixed oil obtained from the fresh livers of the Gadus 
Morrhuce, or cod-fish. There are several species of cod from which 
the oil is obtained other than the one named, but this is the chief 
source of supply. The oil is pale or dark according to its degree of 
freedom from foreign materials. Although the paler oils are gen- 
erally prescribed, there can be little doubt that the darker ones are 
more medicinally active. The most prominent inorganic constituents 
of the oil are iodine, bromine, and sulphuric and phosphoric acids. 
It also contains more or less of the biliary salts. 

Physiological Action. — Cod-liver oil depends on a number of sub- 
stances for its peculiar effect. The iodine certainly exerts certain 
alterative powers, and the oil seems peculiarly adapted to digestion 
and absorption, for cod-liver oil passes through animal membranes 
very readily, probably owing to the biliary salts contained in it. 

It aids in the maintenance of bodily temperature by its oxidation, 
and causes a deposit of fat in the tissues. The oil also seems to influ- 
ence the blood directly, for clinical observation shows that anaemic 
persons become healthy-looking under its use, and Cutler and Brad- 
ford have found that this apparent improvement is a physiological 
fact by the use of Malassez's blood-cell-counting apparatus, the red 
corpuscles being always increased. It has been proved by experi- 
ment that this oil is more readily oxidized than any other. 

The belief among physicians that the effects of cod-liver oil are 
dependent upon some peculiar combination of substances has shown 
itself in the attempts of physiological chemists to isolate the combina- 
tion. One of the best results reached is the so-called "morrhuol" 
of Chapoteau, who seems to have isolated a crystalline substance con- 



COD-LIVER OIL. 161 

taining phosphorus, iodine, and bromine. 3 to 5 grains of this 
preparation are said to represent 1 drachm of the pure oil, and it is 
certainly of value as a medicament in most of the states in which Ave 
use the oil itself. In " colds " which " hang on " and are not readily 
gotten rid of morrhuol is best given in capsule or pill. This sub- 
stance is put on the market in gelatin-coated pills or capsules. 

Therapeutics. — Cod-liver oil is useful in persons who have no tuber- 
cular lesion in the lung or other tissues, but have mucous membranes 
which are readily susceptible to disease. This state has been called 
the pre-tubercular stage of phthisis. Cod-liver oil possesses no cura- 
tive power in cases of well-developed phthisis, and its administration 
in many cases only serves to nauseate and distress the patient or to 
produce an oily diarrhoea through failure of digestion. It may be 
used in the early part of the disease as a food, but not as a cure. In 
chronic rheumatism the drug is often of great service, particularly if 
the disease is largely muscular. Strumous skin lesions depending for 
their existence not only upon scrofulosis, but also upon ancemia, often 
yield to its use. In enlargement of the lymphatic glands, where they 
are not undergoing acute active suppuration, cod-liver oil does good. 
This is a statement requiring explanation. By acute active suppura- 
tion is meant the early formation of pus or the molecular death of the 
parts — not the slow formation characterized by no active change, but 
represented by cold abscess or old sores. If the discharge is chronic, 
the oil does good. In strumous ophthalmia cod-liver oil is of great 
service. In advanced syphilis cod-liver oil is most useful, and in the 
early stages of rickets it ought always to be employed. In marasmus, 
when used by inunction, or taken internally if the stomach will stand 
it, it is one of the best drugs we have. If a few grains of bile-salts, 
consisting of glycocholate and taurocholate of sodium, be added to 
each drachm of oil, it will be very readily absorbed from the skin. 1 

In sciatica and lumbago and in neuralgia cod-liver oil is of service. 
In emphysema of the lungs it is said to be of great value, and certain 
writers commend its use in gout, although others have asserted that it 
is of no value Sometimes old persons, whose digestion is not dis- 
ordered and who have no organic brain disease, complain of giddiness. 
The best treatment for this condition, in many instances, is cod-liver 
oil with doses of quinine, or if these fail wine of ergot and one of 
the bromides may be used. 

Administration. — Owing to its disagreeable taste and smell most 
patients rebel against taking cod-liver oil ; but this can, with a little 
persistence, be readily overcome, so that finally the patient may not 
only not object to its use, but actually like it. This is particularly 

1 These salts may be bought, or made as follows: To about 300 cc. of ox-gall is 
added nearly thrice that quantity of ordinary alcohol, and the flask shaken thoroughly. 
All the mucus is now precipitated and the supernatant fluid is filtered. To the filtrate 
is added a large excess of sulphuric ether, and after a time a plaster-like mass forms 
at the bottom of the vessel, which slowly becomes crystalline. These crystals are now 
placed on a filter-paper and washed with a mixture made up of ether and alcohol, 
equal parts. The filter-paper is dried and the substances then seen are the tauro- 
cholate and glycocholate of sodium. Having carefully removed these salts from the 
paper, they are ready for use. 

11 



162 DRUGS. 

true of young children. The secret of reaching this much-to-be- 
desired state lies in the use at first of doses which may be dropped 
into a teaspoon and the spoon then gently submerged in a glass of 
milk. The oil floats off into the milk in a globule in the centre of the 
tumbler, and if the milk be rapidly gulped down without the oil touch- 
ing the sides of the glass, it will not be tasted. The first gulps must 
be large enough to include the oil. The oil may be taken on a full 
stomach, but as a general rule it is best digested if taken about two 
or three hours after meals, when the gastric contents are about to be 
passed into the small bowel, where the oil is digested ; and if it be fol- 
lowed in fiye or ten minutes by a little pancreatin, its digestibility 
will be much increased. Other modes of ingestion consist in the 
placing of the oil in whiskey or brandy, in the manner which has 
been described with milk, and this method possesses the advantage 
that the alcohol aids very distinctly in the absorption of the oil. 
Sometimes a pinch of salt placed in the mouth before and after the 
oil is taken aids in covering its taste and in its digestion. (See Indi- 
gestion.) Oil of eucalyptus in the proportion of 1 to 100 of the cod- 
liver oil will cover the latter's taste, but many dislike the eucalyptus 
more than the cod-liver oil. The addition of an equal quantity of 
glycerin, with J to 1 drop (0.03-0.06) of the oil of bitter almonds to 
each dose, is often of service. Syrup of bitter orange-peel is one of 
the best covers to its taste. Tomato ketchup has also been used with 
good results. Chewing a piece of smoked herring before and after 
taking the oil is of value to disguise the taste in some cases. The oil 
is readily taken in soft capsules holding from \ to 1 drachm (1.0- 
4.0). Very feAv people are unable to swallow them if they are first 
made slippery by dipping them in water. 

Cod-liver oil is most readily digested when given in single nightly 
doses after supper or after a light meal just before going to bed. After 
a few days it may be given after dinner, and in the course of a week 
after breakfast. If the patient is once nauseated by overdoses, it is 
almost impossible to make the stomach retain the oil. If it cannot 
be digested, a drachm of ether aids in its absorption, or a drink of 
whiskey or brandy may be used instead. Often a simple bitter, such 
as a dessertspoonful (8.0) of compound tincture of cardamom, taken 
in water immediately after the oil is swallowed, aids in its digestion. 

A large number of preparations of cod-liver oil are on the market 
in emulsion, pancreatized and purified till they are nearly tasteless. 
Many of the permanent or perfect emulsions contain more Iceland 
moss or acacia than oil. One of the emulsions widely advertised in 
the street-cars of Philadelphia as "tasteless " has been shown to con- 
tain no oil at all. The pancreatized emulsions are the best if the 
oil is really present in sufficient quantity to do good, as the very fact 
of its being artificially digested adds to its value and the possibility 
of putting more oil into the emulsion. Oil devoid of smell is prob- 
ably devoid of medicinal value, as all the peculiar properties have 
been "purified" out of it, 



COLCHICUM. 163 

COFFEE. 
(See Caffeine.) 

COLCHICUM. 

Colchicum is the corm (Colchici Cormus, B. P. ; Colchici Radix, 
U. S.) and seed (Colchici Semen, U. S. ; Colchici Semina, B. P.) of 
the Colchicum Autumnale, a plant of Europe, containing an alkaloid, 
colchicine, which may be still further changed into colchiceine. While 
the drug is official in the form of the seeds and root, the former are 
rarely employed. 

Physiological Action. — Colchicum is a very powerful drug, and 
when locally applied is an irritant to the gastro-intestinal mucous 
membrane. 

According to the studies of one of the writer's students — Dr. 
Ferrer Y. Leon — the drug has little or no effect when given in mod- 
erate dose on the nervous system, circulation, respiration, or tem- 
perature, only producing changes in these parts when given in poi- 
sonous doses. Jacobi asserts that death is produced by respiratory 
failure, the heart continuing to beat for many minutes after respira- 
tion ceases. The violent gastro-enteritis which is present in colchi- 
cum poisoning certainly has much to do with the fatal result in man. 

Therapeutics. — The employment of colchicum in medicine centres 
around it use in gout and similar states, such as chronic rheumatism 
or rheumatoid arthritis. Indeed, it is almost a specific in acute gout, 
provided that it be pushed until it causes slight griping or laxity of 
the bowels. Care must be exercised under these circumstances that 
" retrocedent gout " does not occur, owing to the manifestations of the 
disease leaving the toe and going to the internal viscera. In some 
cases iodide of potassium should be used in conjunction with the col- 
chicum. This is particularly the case in subacute or chronic cases. 

The use of colchicum in such doses as to cause severe purgation 
or emesis is dangerous, and ought not to be resorted to. Colchicine 
can be used successfully against gout in the dose of j^-q to -^ of a 
grain. 

Poisoning. — The symptoms of poisoning by colchicum are nausea, 
griping, agony in the belly, purging followed by the passing of thick 
mucus, with great and increasing tenesmus, profuse salivation, col- 
lapse, and death from exhaustion and gastro-enteritis. Bloody purg- 
ing is almost never seen. The poisoning is one of the most painful, 
slow, and hopeless poisonings known, and a man taking as much as 
an ounce of the wine of the root or the seed is almost inevitably 
doomed to a terrible death. Tannic acid may be used as a partial 
chemical antidote, and the stomach washed out by the administration 
of emetics and the use of the stomach-pump. Opium is to be used 
to relieve the pain and irritation, and oils are to be given to soothe 
the inflamed mucous membrane. If collapse comes on, external heat 
and stimulants are to be used, and atropine may prove of service 
under these circumstances. 



164 DRUGS. 

Administration. — Colchicum ought never to be used in substance T 
but should be employed in the form of wine of the root ( Vinum Col- 
chici Radicis, U. S.) in the dose of 10 to 20 drops (0.6-1.2), although 
if a marked effect is required 30 drops (2.0) may be used. The 
extract {Extractum Colchici Radicis, U. S.) is given in the dose of 
2 to 3 grains (0.12-0.2), and the fluid extract {Extractum Colchici 
Radicis Fluidum, U. S.) in the dose of 2 to 4 minims (0.1-0.3). 

Of the seeds, the tincture {Tinctura Colchici Seminis, U. S. and 
B. P.) is given in 30- to 90-minim (2.0-6.0) doses; the wine {Vinum 
Colchici Seminis, U. S.) in the same amounts ; and the fluid extract 
{Extr actum Colchici Seminis Fluidum, II . S.) in the dose of 2 to 5 
drops (0.1-0.3). The B. P. preparations, besides those given, are 
Vinum Colchici, dose 10 to 30 minims (0.6-2.0); Extr actum Colchici, 
dose J to 2 grains (0.03-0.13); and Extr actum Colchici Aceticum, 
dose i to 2 grains (0.03-0.13). 



COLLODION. 

Collodium, U. S. and B. P., is a solution of gun-cotton in alcohol 
and ether, and is a clear, syrup-like fluid, smelling strongly of ether. 

Therapeutics. — Collodion is used as an air-tight dressing for small 
wounds and abrasions and for rendering small dressings waterproof. 
A difficulty in its use consists in the contraction which takes place as 
it dries, drawing and puckering the part sufficiently to cause not only 
discomfort, but acute pain. It should be applied with a camel's-hair 
brush over the part affected. 

In boils, when they are beginning in a small pustule or papule 
with an inflamed zone, collodion painted over the spot will generally 
abort the disease. If the boil has burst, this treatment is useless, 
but if it has not the pus should not be liberated, but allowed to 
become inspissated. By this treatment and by the frequent applica- 
tion of a coat or two the trouble eventually disappears. Of course 
this rule only applies to certain cases, and if pain is caused by the 
retention of the pus, it must be evacuated with antiseptic precautions. 
In smallpox the flexible collodion may be used to prevent pitting. 

In gouty inflammations of the joints an application of collodion 
mixed with iodine, equal parts, will often remove the pain, although 
at first the suffering may be increased by this treatment. 

Flexible Collodion. 

Flexible Collodion {Collodium Flexile, JJ. S. and B. P.) is made 
by adding Canada turpentine 5 parts and castor oil 3 parts to ordi- 
nary collodion. It does not contract or become hard, and is gener- 
ally to be preferred to ordinary collodion in the dressing of wounds. 

Styptic Collodion. 
Styptic Collodion {Collodium Stypticum, U. S.) contains tannic 



COLOCYNTH. 165 

acid, and is employed to control small hemorrhages. It is seldom 
used, and its employment is a dirty way of controlling bleeding. 

Cantharidal Collodion. 

Cantharidal Collodion {Collodium Cantharidatum, U. S.) has been 
referred to under the head of Cantharides. Collodium Vesicans, 
B. P., is identical with this preparation, and is used for the same 
purpose. 

COLOCYNTH. 

Colocynthis, U. S., is the fruit of the Citrullus Colocynthis, a plant 
at present largely grown in all parts of the world. It contains an 
alkaloid, colocynthine, and a resin. Neither of these is ever used in 
medicine. Colocynth causes large watery evacuations, and may, in 
very large dose, produce fatal gastro-enteritis. It is official in the 
B. P. as Colocynthidis Pulpa. 

Therapeutics. — Colocynth is never used alone, but always in com- 
bination with other drugs of its class as a hydragogue cathartic. 

In cases of chronic dropsy and for the relief of serous effusions 
this drug is generally given in the form of the compound extract of 
colocynth (Extractum Colocynthidis Compositum, U. S. and B. P.), 
which contains 160 grms. of colocynth, 500 grms. of purified aloes, 
140 grms. of the resin of scammony, 60 grms. of cardamom, and 40 
grms. of soap. In the dose of 5 to 20 grains (0.3-1.3) this acts as a 
powerful watery purge. The extract {Extractum Colocynthidis, JJ. S.) 
is given with other drugs in the dose of 2 to 5 grains (0.13-0.3) as a 
purge. The following is a useful form in which to administer it : 

R. — Extract, colocynth gr. xxx (2.0). 

Extract, belladonna? gr. ij (0.1). 

Extract, nucis vomicae gr. ij (0.1). — M. 

Ft. in pil. No. x. 
S. — One in the morning. 

Colocynth is one of the principal ingredients in compound cathartic 
pills {Pilula? Catharticoe Composite?, U. S.) Each pill contains : com- 
pound extract of colocynth, 1^ grains (0.09); abstract of jalap and 
calomel, of each 1 grain (0.06); gamboge, \ grain (0.015). This pill 
is not to be used constantly. The IT. S. P. of 1890 also orders a 
pill (Pilulai Catharticoe Vegetabilis, U. S.) which contains compound 
extract of colocynth, extract of hyoscyamus, extract of jalap, extract 
of leptandra, resin of podophyllin, and oil of peppermint. 

The preparations of the B. P. not official in the U. S. P. are : 
Pilula Colocynthidis Composita, composed of colocynth-pulp, aloes, 
scammony, sulphate of potassium, and oil of cloves, dose 5 to 10 
grains (0.3-0.65); Pilula Colocynthidis et Hyoscyami, dose 5 to 10 
grains (0.3-0.65). 



166 DRUGS. 



CONDURANGO. 



Condurango is the bark of Condurango Blanco, a tree of Colombia, 
South America. It was introduced into medicine in 1873 as a cure 
of gastric cancer, and at one time had a favorable reputation. We 
now know that, so far as the morbid growth is concerned, its action 
is valueless, but there is no doubt that it diminishes the severity of 
the symptoms in many cases by exercising a sedative effect on the 
gastric mucous membrane. It tends to relieve the accompanying 
catarrh through its action as a stomachic. 

The bark is never employed as the bark, but in the form of the 
fluid extract, dose 1 to 2 drachms (4.0-8.0). Sometimes it is given 
in the form of a decoction made by adding 1 part of the bark to 8 
parts of water. Often it is wise to add to the prescription a little 
hydrochloric acid to substitute the natural acid of the stomach which 
is always lacking in such cases. 

CONIUM. 

Conium (U. S.) is the leaves and fruit of the Conium Maculatum. 
The plant grows in Europe and the United States, and contains a 
resin know T n as coniine. This drug is official in the B. P. as hem- 
lock-leaves (Conii Folia) and hemlock-fruit (Conn Fructus). 

Physiological Action. — When conium is taken in very full dose, it 
causes weakness and a sense of relaxation, giddiness, staggering, and 
disordered vision, with failure of the circulation. 

Nervous System. — Conium causes paralysis of the motor nerves, 
and, if the dose be extraordinarily large, depression of the sensory 
nerves. Upon the spinal cord it exerts a feeble depressing influence, 
but has no positive effect, while the fact that consciousness continues 
almost up to death shows that the intellectual portion of the cerebrum 
escapes its influence. 

Circulation. — The action of the drug upon the circulation is 
depressant. It causes at first a fall of arterial pressure, then a rise, 
due to the asphyxia caused by nervo-muscular failure of the respiratory 
apparatus. Finally a constant fall of pressure takes place. 

Respiration is depressed, because of the influence of the drug on 
the nerve-trunks supplying the respiratory muscles. 

Therapeutics. — Conium holds an unimportant place in the drug- 
list of to-day. It has little value except in spasms due to irritation 
of a nerve-trunk, when it may be of service. In spasms of cortical 
or spinal origin other drugs should be used, as it is evident that 
conium has really no effect in quieting the central nervous proto- 
plasm, but only prevents the impulses which are sent out from mani- 
festing themselves in movements of the muscles. The powdered 
leaves or other preparations may be smeared over poultices to relieve 
the pain of ulcers and cancers, and it certainly does good in such 
instances. 

Administration. — The dose of the alcoholic extract (Fxtractum 
Conii, U. S.) is from J to 1 grain (0.03-0.06), and of fluid extract 



COPAIBA. 167 

{Extr actum Conii Muidum, U. S.) 2 to 6 drops (0.1-0.13). The 
dose of the tincture (Tinctura Conii, B. P.) is 10 to 30 drops (0.65- 
2.0). Coniine is a liquid alkaloid which should never be used. The 
dose would be about -^ of a grain (0.001). The dose of the hydro- 
bromide of coniine is said by Helbing to be -J- to J a grain (0.01-0.03). 
The preparations in the B. P. made from the leaves are : Cataplasma 
Conii, for external use; JExtractum Conii, dose 2 to 6 grains (0.13- 
0.4) or more; Succus Conii, dose 30 minims to 2 fluidrachms (2.0-8.0) 
or more; Vapor Conii, for inhalations; and Pilula Conii Composita, 
composed of extract of hemlock and ipecac, dose 5 to 10 grains 
(0.3-0.6). Vapor Conii consists of the juice of hemlock (Succus 
Conii) -J- ounce (16.0), liquor potassa 1 drachm (1.0), and distilled 
water 1 ounce (32.0), 20 drops (1.2) of this mixture are placed in 
lot water in an inhaler, and so employed for the relief of irritative 
coughs or spasmodic asthma. 

It is to be remembered that the variability of the drug, so far as 
power is concerned, is very great — so great as to make it unreliable. 
For this reason a small dose should be given at first and the amount 
gradually increased. 

Poisoning. — A prominent symptom of poisoning by conium is drop- 
ping of the eyelids (ptosis), due to paralysis of the oculo-motor nerves, 
and staggering and inability to walk. Its treatment consists in the 
use of strychnine as a respiratory and nervous stimulant, the employ- 
ment of external heat, and the use of cardiac stimulants if the circu- 
lation fails. The stomach is to be emptied by emetics or the stomach- 
pump before the antidotes are used. 



CONVALLAKIA. 

This drug is derived from the rhizome and root-stalk of Conval- 
laria Majalis. It is employed in medicine as a cardiac tonic to fulfil 
the indications which direct us in the use of digitalis. While by no 
means so valuable a drug as foxglove, it sometimes acts better in an 
individual case than the older remedy. The heart is not greatly 
slowed by it, but it is particularly useful in cases of arhythmia and 
" cardiac hurry." 

The dose of the fluid extract (Extr actum Convallarice Fluidum, 
TJ. S.) is from 4 to 8 drops (0.2-0.5) three times a day. The tinc- 
ture (Tinctura Gonvallaria) is given in the dose of 5 to 20 minims 
(0.3-1.3). Convallamarin is a glucoside of convallaria which has 
been used in the dose of \ a grain (0.03) three times a day. Some 
clinicians think it ought to be given but once a day on account of 
a danger of cumulative action. 



COPAIBA. 

The Copaiba of the U. S. P. and B P. is really the balsam or 
the oleoresin of Gopaifera Langsdorffii, and is a clear, transparent 



168 DRUGS. 

liquid of oily consistency, of a pale-yellow color and a peculiar odor. 
From it is distilled an oil (Oleum Copaibas, U. S. and B. P.) which is 
of little value. 

As copaiba is an oleoresin, the term " oleoresin of copaiba " is 
often used to distinguish it from the oil. 

Therapeutics. — Copaiba is used for the purpose of stimulating the 
mucous membranes of the genito-urinary tract, particularly when they 
are depressed after a period of inflammation, as in the later stages of 
gonorrhoea. In cases suffering from chronic urethritis with anaemia 
and debility the following prescription is useful : 

R. — Oleoresinse copaibse gj (4.0). 

Oleoresinse cubebse gtt. iv (0.2). 

Ferri et ammonii citratis gr. xx (1.3). — M. 

Ft. in capsule No. x. 
S. — One t. d. after meals. 

Copaiba is employed in subacute and chronic bronchitis as an expect- 
orant. In the treatment of subacute pyelitis, cystitis, and dysentery 
it is of value. In dropsy due to slow renal changes it will often be 
of service. 

Administration. — Copaiba itself is given in the dose of 5 to 20 
minims (0.3-1.3) in capsule or in emulsion. The oil of copaiba 
(Oleum Copaibas, U. S. and B. P.) is given in capsule or emulsion, 
preferably in the former, in the dose of 10 to 20 minims (0.65-1.3) 
two to four times a day. Sometimes it is dropped on sugar and so 
administered. Massa Copaibas, TJ. S., is made by rubbing up copaiba 
with magnesium, but this is a useless and clumsy way of using it in 
the pill form. 

The drug is eliminated in the urine, and gives the test for albumin 
with nitric acid. 

In some cases it causes urticaria, which soon ceases on the with- 
drawal of the drug. 

COPPER. 

Cuprum is never used in the form of the metal itself, but chiefly 
as the sulphate, which appears in commerce as a blue, clear, some- 
what efflorescent salt. It is soluble in 4 parts of cold water, 2 of 
boiling water, but is not soluble in alcohol, 

Physiological Action. — Copper sulphate, when locally applied to a 
mucous membrane, acts as a powerful astringent, or on the surface of 
an ulcer as a mild and superficial caustic. Upon the nervous system 
in cats it acts as a depressant poison when given hypoderruically, 
finally causing death from respiratory failure. When given in over- 
dose by the stomach it causes death by violent gastro-enteritis and 
exhaustion. The symptoms do not generally come on for an hour, 
and consist in burning pain in the stomach, a copperish or metallic 
taste in the mouth, followed by vomiting of bluish liquids and glairy 
mucus. With the vomiting, purging comes on, the passages at first 
containing the contents of the intestine, and finally mucus and blood. 
Convulsions of an epileptiform character are present, and constant 



COPPER. 1 69 

and profuse salivation is not infrerjuent. After death fatty degene- 
ration of the liver and kidneys has been noticed, and it is not at all 
uncommon for jaundice to appear after the first twenty-four hours, 
if the patient survives so long. This jaundice is dependent upon 
changes in the blood. The treatment of the poisoning consists in 
the primaiy use of the chemical antidote, which is the yelloiv prus- 
siate of potassium, and the administration of emollient or demulcent 
substances, such as sweet oil and white of eggs, followed instantly by 
emetics or the stomach-pump. If emesis and purgation are already 
active, emetics are of course contraindicated, and counter-irritation 
is to be employed over the stomach and intestines in the shape of a 
mustard plaster of moderate strength, w T ith opium to allay irritation 
and relieve pain. 

Chronic copper poisoning is almost never seen, and, although the 
metal is widely used for coloring canned green vegetables, it seems 
to be harmless in such small amounts. 

. Therapeutics. — Sulphate of copper (Qupri Sulphas, U. S. and 
B. P.), in the dose of 5 to 7 grains (0.3—0.4),. may be used as a rap- 
idly-acting emetic which only acts upon the stomach, not the vomit- 
ing centre. As it is irritant, the emetic dose ought not to be repeated, 
but if emesis does not occur the sulphate of zinc or mustard should 
be used in its stead. Indeed, it may be said of sulphate of copper 
that it should never be given as an emetic, except in phosphorus poi- 
soning, when it acts as the chemical antidote. Even here its use 
must be most cautious, for Thornton has proved that an antidotal 
dose of copper sulphate given to a dog poisoned with phosphorus may 
produce death before the phosphorus can do so. In pill form it is 
sometimes given in diarrhoeas depending upon ulceration of the bowels. 
The dose should be \ to 1 grain (0.015-0.06) combined with opium. 

In some states of the body, particularly in skin diseases of the dry 
type and in persons with tubercular tendencies, copper seems to act 
like arsenic, and may be used in minute doses of y 1 ^- of a grain (0.006) 
or less three times a day where arsenic is not well borne. In small 
doses it is said to be a direct stimulant to the tissues, and to increase 
the firmness of the flesh and strength of the normal man. Very 
recently strong claims for copper as a remedy for anoemia have been 
put forward, particularly if it is employed as the arsenite of copper, 
when the action of the arsenic and copper together produces a good 
effect. 

Injected into the rectum in the strength of 5 to 20 grains (0.3- 
1.3) to the ounce (32.0), the drug will be found of service in those 
cases of diarrhoea which arise in the lower bowel and are dependent 
upon ulceration. 

Locally applied, sulphate of copper is useful, in the solid form or 
in powder, in the treatment of indolent ulcers. In chronic conjunc- 
tivitis or in cases of tinea tarsi — that is, tinea on the margin of the 
eyelids — a crystal of the sulphate may be drawn over the diseased 
spot; or a weak solution of 1 to 3 grains (0.06-0.18) to the ounce 
(32.0) of water may be dropped into the eye in subacute conjunctivitis. 

In relaxed sore throat, as a gargle, in the strength of 4 grains (6.2) 



170 DRUGS. 

to the ounce, it is often of service. Nitrate of copper (Cupri Nitras, 
B. P.) and acetate of copper [Cupri Acetas) serve the same purpose 
as the sulphate. 

CREOSOTE. 

Creosote (Creosotum, U. S. and B. P), as employed in medicine, 
should always be derived from the destructive distillation of beech- 
wood and be designated " beechwood creosote." Much of that sold 
is derived from coal-tar, and is far less useful. Chemically, creosote 
is almost identical with carbolic acid. Clinically, it is very different. 
It is a powerful antiseptic. Beechwood creosote should be of a red- 
dish-amber hue and about as thick as olive oil. Its physiological 
action is almost identical with that of carbolic acid, and in poisoning 
by creosote the same antidotes as are employed in carbolic-acid poi- 
soning — namely, soluble sulphates — should be used. 1 Creosote con- 
tains 60 per cent, of guaiacol and 40 of cresol, not creosol. Guaiacol 
is sometimes used in place of creosote in the dose of 1 to 2 minims 
(0.06-0.13). (See Guaiacol.) 

According to the studies of Imbert, creosote is eliminated chiefly 
by the kidneys in the form of guaiacol sulphate and creosol sulphate 
of potassium. Elimination does not go on very rapidly, for this 
investigator found it completed in about twenty-eight hours. A small 
amount of the drug is eliminated by the lungs. 

Therapeutics. — During the past few years creosote has been largely 
prescribed in phthisis and chronic bronchitis, and some of the results 
reached by its use have undoubtedly been of value. It has also been 
inhaled from sponges with great relief, and even has been injected 
into the lungs by the trachea or through the chest-wall. (See article 
on Tuberculosis.) In the treatment of chronic bronchitis creosote 
may be placed in boiling water and inhaled in the steam. Under 
these circumstances it at least relieves the foetor of the breath, and 
this method often gives more rapid relief than any other measure in 
ordinary subacute inflammation of the bronchi. The beginning dose 
when the drug is given internally is 2 to 5 drops (0.1-0.35). Applied 
on a pledget of cotton to the cavity of a tooth, creosote often relieves 
toothache. 

When given in phthisis the following prescription may be used, 
or the drug may be placed upon a Yeo's inhaler and inhaled in that 
way : 

r*. — Creosoti (beechwood) foiij (12 0) 

Tinct. gentian, comp f?j (32.0). 

Spt. vini rectificati fo y i'J (256.0). 

Vini Xerici Oij (1 litre). — M. 

S. — A tablespoonful in a wineglassful (16.0: 64.0) of water three times a day. 

Creosote is useless, so far as producing a cure is concerned, if 
tuberculosis is more than incipient, and ought not to be employed if 
it disorders the stomach. The drug is contraindicated in phthisis 
if fever or haemoptysis be present, and those patients who have little 

1 See University Medical Magazine, 1889. 



CREOLIN. 171 

fever and a chronic phthisis are the most favorable subjects for its 
employment, as are those in which the bronchial tubes seem to be 
much affected. Inhalations of the drug often give relief in the 
advanced stages of phthisis, and decrease the cough, allay the laryn- 
geal dryness, and aid expectoration. When creosote is given hypo- 
dermically in phthisis, it should be given in the following formula : 

R.— Creosoti f^ij (8.0). 

Olei amygdal. dulcis f^ij (8.0).— M. 

S. — 10 minims (0.65) to be injected deeply into tissues below the scapula. 

Unless the patient is fastidious, the creosote may be dropped into 
half a glass of milk and taken in this three times a day. Often as 
much as a drachm can be given by gradually producing tolerance 
through ascending doses, and it is worthy of note that in most in- 
stances large doses are required if satisfactory results are expected. 

In the treatment of subacute laryngitis a fine spray of 1 to 2 
minims (0.05-0.1) of creosote, 4 grains (0.2) of menthol, and 1 ounce 
(32.0) of alboline is of service used several times a day, or a mixture 
composed of creosote 10 minims (0.65), chloroform spirit 10 minims 
(0.65), and alcohol 20 minims (1.3) may be placed on an inhaler and 
inhaled. 

Creosote is a very valuable remedy in cases of indigestion with 
fermentation either from meats or sweets when given in the dose of 
\ to 2 minims (0.03 to 0.1) after meals. 

While ordinary medicinal doses of creosote rarely cause disagree- 
able symptoms, except some disorder of the stomach or bowels when 
pushed in full doses, the physician who is ordering large amounts 
should be alwa}*s on the lookout for toxic symptoms. These consist 
in vertigo, headache, and a tendency to stupor, or the urine becomes 
smoky in appearance, as in carbolic-acid poisoning. If any of these 
signs of overdosing appear, the drug must be reduced in dose or 
stopped altogether. 

The preparations of creosote are Aqua Creosoti, U. S. and B. P., 
given in the dose of 1 to 3 fluidrachms (4.0-12.0); Mistura Creosoti, 
B. P., dose 1 to 2 fluidounces (32.0-64.0) ; JJnguentum Creosoti, B. P., 
for local application ; and Vapor Creosoti, B. P., used by inhalation. 



CRBOLIN. 

Creolin is a liquid cresol, a coal-tar product, possessing marked 
antiseptic but comparatively slight poisonous properties. In appear- 
ance it is a dark -brown fluid, and is derived from soft coal. It is of 
the consistency of syrup. When added to water it forms a white 
cloud and mixes thoroughly, forming an emulsion up to 12 per cent, 
of the drug. 

Therapeutics. — Creolin is used as an antiseptic in the lying-in 
state, as a wash for the hands, and for vaginal irrigation. It cannot 
be used as a solution in which to place instruments, as it makes so 
opaque a mixture with water as to prevent their being seen at the 



172 DRUGS. 

bottom of the dish. When used as a vaginal douche it should be 
employed in the strength of 2 per cent. One property of value is 
that it forms a slippery coating over the maternal parts during partu- 
rition. In the treatment of cystitis in the female, Parvin highly 
recommends it as a vesical wash in the strength of a 1 per cent, solu- 
tion, or, after the bladder becomes accustomed to its use, in a 2 per 
cent, solution. According to Kretzschmar and others, a solution of 
1 to 500, used with a syringe, is useful in otorrhoea, 1 to 100 in nasal 
ulcers, and 1 to 1000 as a nasal douche in rhinitis, when there is 
much discharge with the formation of crusts. Creolin has also been 
used as an injection in the proportion of 5 parts in 1000 of water for 
dysentery and entero-colitis with success. 

In the eye Alt has used a 1 to 2 per cent, solution in the treat- 
ment of blepharitis, keratitis, and phlyctenular ophthalmia. 



CROTON CHLORAL. 

Croton Chloral, or Butyl Chloral Hydras, B. P., has a physio- 
logical action closely allied to chloral itself, but possesses more anal- 
gesic power and is very much less depressant to the heart and circu- 
lation. The dose for the production of sleep is the same as chloral, 
5 to 20 grains (0.3-1.3) in syrup. 

Therapeutics. — Croton chloral is infinitely preferable to chloral in 
sleeplessness due to pain. 

In facial neuralgia and migraine it is exceedingly efficacious, par- 
ticularly if the fifth nerve be involved. In headaches due to eye- 
strain, and in those associated with sick stomach, but not due to 
gastric indigestion or nervous debility, croton chloral is of service. 
Curiously enough, it is valueless in toothache, but does good in the 
neuralgia due to decayed teeth. 

Administration. — Croton chloral should be used in pill form in the 
dose of 3 to 5 grains (0.2-0.3) every two hours till the pain is 
relieved or sleep comes on, or it may be given in solution or syrup 
of acacia and water, or water and glycerin. It has been used in as 
large a dose as 60 grains (4.0), but 20 to 30 grains (0.65-2.0) ought 
to be the maximum dose as a general rule. 



CROTON OIL. 

Croton oil (Oleum Tiglii, U. S. ; Oleum Crotonis, B. P.) is an 
exceedingly irritant oil derived from Croton Tiglium, a small tree of 
India. The oil is pale yellow and of a complex character. Applied 
to the skin for any length of time, it is an intense irritant, producing 
blisters or pustules. 1 drop (0.06), placed on the tongue with 5 drops 
(0.35) of sweet oil, acts as a violent watery purge, and, owing to the 
smallness of its dose, it is frequently employed to revulse the uncon- 
scious, as in cerebral congestion. In delirium it is used for the same 
purpose, and may be given to maniacs who are suffering from an 



cusso. 173 

attack of cerebral congestion or obstinate constipation, owing to the 
smallness of its dose and rapidity of action. The dose is 1 drop (0.06) 
placed on the tongue with sweet oil or given in emulsion or in pill. 
It ought never to be used when there is any irritation of the stomach 
or bowels. As a counter-irritant it is sometimes applied over a ten- 
der nerve or to the chest in the treatment of bronchitis, in the pro- 
portion of half-and-half with sweet oil. Thus applied, it may be 
absorbed and cause purging. The treatment of poisoning by croton 
oil is identical with that of gastro-enteritis. (See Gastro-enteritis.) 
Linimentum Crotonis is a preparation of the B. P. which is employed 
as a counter-irritant liniment for sprai?is and in muscular rheumatism. 



CUBEBS. 

Cubebs (Cubeba, TJ. S. and B. P.) are the unripe fruit of Piper 
Cubeba, a plant of Java. They consist in wrinkled or rough black 
bodies about the size of small peas, and have an aromatic pungent 
taste. They contain a volatile oil, cubebic acid, and cubebin. The 
drug should not be kept in powdered form, as it loses its powers, but 
should be powdered as needed. Overdoses of cubebs cause gastro- 
intestinal and genito-urinary inflammation. 

Therapeutics. — Cubebs are used in the advanced stages of gonor- 
rhoea where a tendency to a chronic discharge is present. Some sur- 
geons have used them in the early stages as an abortive treatment, 
but this is a bad practice. In cold in the head the powdered berries 
may be snuffed up the nostril, provided that the stage of secretion is 
well established. They ought not to be used before this stage. In 
the treatment of chronic or subacute bronchitis the oleoresin of 
cubebs is very useful in some cases (see Bronchitis), and in the form 
of cubeb cigarettes the drug is much used as a remedy for hoarseness 
due to subacute laryngitis. 

Administration. — Cubebs may be given in powder in the dose of 
10 to 60 grains (0.65-4.0), in the fluid extract {Extr actum Cubeba? 
Fluidum, TJ. S.) 10 to 30 drops (0.65-2.0), and in the form of the 
tincture (Tinctura Cubebce, TJ. S. and B. P.) in the dose of 10 drops 
to ^ an ounce (0.65 : 16.0). 

The dose of the oleoresin {Oleoresina Cubeba?, TJ. S. and B. P.) 
is 2 to 20 drops (0.1-1.3) three times a day, and it may be given in 
capsules or emulsion. The troches of cubebs (Trochisci Cubebce, 
TJ. S.) are used for the relief of pharyngitis of a chronic type. The 
dose of the oil {Oleum Cubeba?, TJ. S. and B. P.) is 5 to 20 minims 
(0.3-1.3). 

CUSSO. 

Cusso, TJ. S. and B. P., sometimes called Kousso, is derived from 
Brayera Anthelmintic a, a plant of Abyssinia. In the TJ. S. P. of 
1880 it was called Brayera. It contains a volatile oil, tannic acid, 
and koosin or taeniin. The drug is used against the tape-worm, and 



174 DRUGS. 

is most valuable as a vermifuge, also possessing the advantage of 
safety. It should be used in an infusion {Infusum Bray era) in the 
dose of \ an ounce (16.0) of the powdered flowers to a pint (500 
cc.) of water, and be taken in the morning on an empty stomach. 
(See Worms.) Koosin may be used in the dose of 20 to 40 grains 
(1.3-2.5) in capsule. The fluid extract (Extr actum Ousso Fluidum) is 
given in the dose of \ an ounce (16.0). It has been said that the 
drug is apt to cause abortion in pregnant women, but this is not 
known to be a fact. Infusum Ousso, B. P., is given in the dose of 
4 to 8 fluidounces (128.0-256.0). 



CYANIDE OP POTASSIUM. 

Cyanide of Potassium (Potissii Cyanidum, U. S. and B. P.) is 
used in the same way and for the same purpose as hydrocyanic acid. 
(See Hydrocyanic Acid.) The dose is -^ to y 1 ^ of a grain (0.006). 

The following prescriptions may be used in cases suffering from 
bronchitis or phthisis accompanied with excessive cough : 

R. — Potassii cyanid • . . gr. ij (0.1). 

Morphinse sulph gr. j (0.05). 

Acid, sulph. arom f^ij (8.0). 

Syr. pruni virginianse q. s. ad f Jiij (96.0). — M. 

S. — Teaspoonful (4.0) three times a day. 

Or as follows : 

R . — Potassii cyanid gr. ij (0.1). 

Ammon. chloridi ^ij (8.0). 

Acid, hydrochlor. dil f gj (4.0). 

Elix. calisayse q. s. ad f 3iij (96.0). — M. 

S. — Teaspoonful (4.0) three or four times a day. 



DERMATOL. 

(See Bismuth Subgallate.) 

DIGITALIS. 

Digitalis, U. S., is obtained from the leaves of Digitalis Purpurea, 
or foxglove, of the second year's growth. The leaves are official in 
the B. P. as Digitalis Folia. It contains a number of substances, 
none of which act as does the crude drug. In other words, all these 
compounds must act together to be therapeutically active. Among 
the substances so far isolated from digitalis by chemists may be 
named digitalin, digitalein, digitoxin, digitin, and digitonin. Several 
of these are simply compounds of the others. Digitalin, so called, 
occurs in two forms, amorphous and crystalline. The crystalline digi- 
talin (French) is largely digitoxin, while the amorphous is composed 
of digitonin, digitalein, and digitalin. A pure digitalin has been 



DIGITALIS. 175 

isolated, but it is not on the market. Digitoxin and pure digitalin 
are the two most active principles yet found. None of these substances 
should be used in medicine to take the place of digitalis. 

Physiological Action. — Digitalis is apt to irritate mucous mem- 
branes which are already slightly out of order, and for this reason 
should not be given by the mouth in cases of gastritis and allied 
states. 

Nervous System — The action of digitalis upon the nervous sys- 
tem is only manifested when poisonous doses are used. Small toxic 
doses decrease reflex action by stimulating Setschenow's reflex inhib- 
itory centres in the medulla, and finally by depressing the spinal cord. 
Convulsions are sometimes seen as a result of the disorder of the cir- 
culation at the base of the brain, owing to the disturbed and abortive 
action of the heart. Finally, the motor nerve-trunks themselves are 
depressed. 

Circulation. — Upon the circulatory system digitalis exerts its 
chief influence. In moderate amounts it increases the pulse-force and 
arterial pressure, slows the pulse, and increases the size of the pulse- 
wave. The increase of pulse-force is due to a stimulating influence 
exercised upon the cardiac ganglia and the muscular fibres of the 
heart ; the rise of arterial pressure is caused by this increased pulse- 
force and pulse-volume, and by a stimulation of the vasomotor centre 
and the muscular coats of the blood-vessels, whereby a contraction 
occurs in the walls of the arteries and arterioles. The slow pulse is 
produced by stimulation of the pneumogastric centre and the periph- 
eral ends of the vagus neves. The increase in the volume of the pulse 
is due to this influence on the vagi, for, the pneumogastric nerves 
being stimulated, the diastole of the heart is more full and complete 
and occupies a greater length of time. The result of this delay is 
that the ventricles become thoroughly distended, and on contracting 
drive on a much larger wave of blood through the aorta than is nor- 
mally sent out. This is important to remember when using the drug 
in heart disease and other states. While we do not know that the 
vagi are the trophic nerves of the heart, we have a large amount of 
evidence in favor of such a view, and it has long been thought that 
digitalis was not only a heart stimulant, but a heart tonic. If the 
trophic nerves of the heart are stimulated by digitalis, it at once 
becomes evident that it is a doubly useful remedy. 

The action of digitalis upon the heart is a double one, in that it 
creates two opposing forces. By the action on the heart-muscle it 
steadily strives to cause contraction or systole of the ventricles ; by 
the action on the vagi it equally steadily struggles to produce diastole 
or dilatation of these cavities. In medicinal dose neither of these 
tendencies gets the upper hand, for both are equally excited, so that 
now increased systole occurs, now increased diastole. 

In poisoning, on the other hand, or in instances where overdoses 
have been given, so much stimulation is caused that the heart beats 
now slow, now fast, now strong, now weak — slow when the vagi over- 
come systole, fast when systole overcomes the vagi ; strong when sys- 
tole escapes from the inhibitory nerves, weak when the ventricles 



176 DRUGS. 

can scarcely contract because the vagi are holding the ventricles open. 
In man we frequently see this irregular pulse replaced by an exceed- 
ingly rapid pulse, which is shuttle-like in character. This is probably 
due to a depression of the peripheral ends of the vagus nerves. In 
the frog digitalis nearly always causes, when given in full doses, an 
arrest of the heart in systole, while in man and the higher animals 
the arrest is in diastole. 

If the patient who has taken a poisonous dose be raised up, he may 
drop dead, owing to the still more active disturbance of the balance 
of power in the heart caused by the calls for blood due to the erect 
position ; and under these circumstances the heart beats so fast that 
it has not time to get enough blood into it to pump anything out, or 
so feebly that the dilated ventricles are never emptied. Finally, a 
fall of arterial pressure ensues, not because the vasomotor system is 
depressed, but because the heart cannot pump out enough blood to 
fill the blood-vessels. 

Respiration. — Digitalis has almost no effect on this function 
unless the amount be poisonous, when respiration is slowed. 

Temperature. — Upon the normal bodily temperature digitalis 
has little or no effect in medicinal dose. In poisonous dose it lowers 
temperature. In fever the drug seems to cause a fall of a small 
amount with some constancy, but it can rarely be used for any anti- 
pyretic influence. High temperatures prevent digitalis from acting 
on the circulatory system. This is an important point to be remem- 
bered in its therapeutic use. 

Kidneys, Tissue-waste, and Elimination. — Digitalis has almost 
no effect over the kidney structure itself, and does not to any extent 
stimulate the reral epithelium. The cause of the increased urinary 
flow produced by digitalis in cases of cardiac dropsy depends upon 
the removal of congestion of the kidneys and the increased arterial 
pressure and improved circulation brought about by the drug. 

Upon tissue-waste digitalis seems to have little effect, and there is 
still some discrepancy in the reports as to the amount of urea cast off 
under its use, some investigators saying it is increased, others that it 
is diminished. 

We do not know how the drug is eliminated, as chemists have 
never been able to find it in the urine. It is probably oxidized in 
the body. 

Poisoning. — The slow, full pulse, followed by the hobbling, dicrotic, 
shuttle-like pulse-beats, and the angry, tumultuous cardiac beat against 
the chest- wall, afford a combination of symptoms characteristic of the 
over-action of digitalis. The pulse may be full and slow when the 
patient is lying down, but at once becomes irregular on his sitting up. 

Often when the patient has by error received too much of the drug 
the finger can scarcely note any pulse at the wrist, while the ear placed 
over the heart shows it to be beating Avildly, as though it would break 
out of the chest. It is important that the weak pulse at the wrist be 
not taken as the only guide as to the state of the patient, for this very 
reason. The physician should always auscalt the prsecordium before 
reaching an opinion as to the action of digitalis. 



DIGITALIS. • 177 

As the poisoning progresses vomiting may come on, exophthalmus 
occurs, and a peculiar blue pearliness of the sclerotic coat of the eye 
is seen. Consciousness is generally preserved nearly to the last. 
Death from digitalis poisoning may be put off for days or occur in 
two hours or even less. Headache is often a severe symptom. 

Treatment of Poisoning. — Tannic acid is to be given as a chem- 
ical antidote ; emetics and the stomach-pump are to be used, the former 
only when the drug has not yet been absorbed, for if the heart is much 
affected emetics are dangerous. External heat is to be applied, par- 
ticularly about the abdomen ; the maintenance of a horizontal posi- 
tion must be insisted upon, and the use of tincture of aconite, as the 
physiological antidote, resorted to. 

Therapeutics. — Much unfortunate misunderstanding concerning the 
action of digitalis has arisen, and while some call it a circulatory stim- 
ulant, others think it a circulatory depressant. The first class base 
their belief on the signs of increased arterial pressure and cardiac power, 
the others on the fact that it slows and steadies an irritable, rapidly- 
acting heart, and they overlook the other signs. Digitalis is a car- 
diac stimulant, and not a depressant. The quieting of irritability by 
it is the quietness produced by the drink of whiskey or coffee taken 
by the speaker before mounting the platform or the pugilist before 
he enters the ring, to steady his nerves and make him firm. If digi- 
talis is used to decrease arterial tension, its dose must be dangerously 
large. (See Physiological Action.) 1 

Digitalis is of value in all cases of cardiac disease where the con- 
dition is one in which the heart fails to do its proper amount of work. 
If simple hypertrophy or excessive compensatory hypertrophy exists, 
it is harmful. It is of less value in aortic regurgitation than in any 
other lesion, because the prolongation of diastole allows greater oppor- 
tunity for the blood to fall back into the ventricle. In some instances 
of mitral regurgitation the drug does harm by over-distending the 
auricle through ventricular stimulation, which results in an increase 
in the regurgitant flow, and we can never tell before trying it which 
cases will be so affected. In cases where the heart is irritable, palpi- 
tation present, and indigestion not the cause of the trouble, digitalis 
is of service. (See Heart Disease.) 

In the second stage of pneumonia digitalis is invaluable (see Pneu- 
monia), and in exhausting fevers, in small doses, is of great service. 
In congestion of the lungs in the typhoid state it will drive out the 
blood from the part congested and relieve stasis. 

In cardiac weakness from collapse, injury, poisoning, or shock digi- 
talis is of service, particularly in aconite poisoning, where it is the 
physiological antidote. Owing to the slowness of its action it should, 
however, be preceded by ammonia and alcohol where the need is 
pressing. In muscarine poisoning digitalis is the antidote. 

As a diuretic digitalis may be used where the kidneys are con- 
gested and the circulation is sluggish. Where the renal structure is 
diseased other drugs should take its place, or it should be combined 

1 It is absolutely necessary for the student to turn to the article on Heart Disease 
and to read it carefully in order to understand the action of digitalis in disease. 
12 



178 DRUGS 

with more active renal remedies, such as squill or caffeine, or in very 
chronic cases with compound spirit of juniper. 

In some cases a cumulative action occurs which consists in the 
failure of the drug to appreciably influence the circulation for some 
days, only to exert all its power suddenly and produce symptoms of 
poisoning. This is particularly apt to occur where the removal of 
ascites or dropsy takes place by tapping after the drug has been taken 
for a long period. It is thought that the sudden withdrawal of pres- 
sure upon the great vascular trunks of the body-cavities causes the 
absorption of the drug with the juices of the tissues where it has 
remained in inactivity. 

The contraindications to the use of digitalis are marked atheroma 
of the blood-vessels, aneurism, apoplexy, and any state of arterial 
excitement. 

Administration. — The official preparations of digitalis are the tinc- 
ture (Tinctura Digitalis, U. S. and B. P.), dose 10 to 20 drops (0.65- 
1.3) ; the infusion (Infusum Digitalis, U. S. and B. P.), 1 teaspoon- 
ful to 4 teaspoonfuls (4.0-16.0); the fluid extract (Mxtr actum Digi- 
talis Fluidum, U. S.), dose 1 to 2 drops (0.05-0.1); the extract 
(Fxtr actum Digitalis, U. S.), J of a grain (0.015); and the powdered 
digitalis-leaves (Digitalis Folia, B. P.), dose 1 to 4 grains (0.05-0.2), 
generally given in a pill. The tincture is the preparation most com- 
monly used, and is most satisfactory, although the infusion has been 
thought of greater value, without any good reason, 

The dose of digitalin, which ought not to be used, is -J*- of a grain 
(0.001). 

DIURBTIN. 

(See SODIO-SALICYLATE OF THEOBROMINE.) 

DUBOISINB. 

Duboisine is the alkaloid of the leaves of Duboisia myoporoides, a 
plant of Australia. The crude drug is little used in medicine, but 
duboisine is used as a mydriatic under the same conditions as atro- 
pine, and more largely still as a hypnotic in insanity, interchangeably 
with hyoscine. The dose of duboisine sulphate hypodermically as a 
hypnotic is -g 1 ^- to ^ of a grain (0.0008-0.001). The clinical experi- 
ence so far adduced would seem to.indicate that it tends to decrease 
urinary secretion and to disorder the digestion, producing at the same 
time a soapy taste in the mouth, with excessive dryness of the mucous 
membrane. Barely it causes profuse salivation or sweating in those 
who have an idiosyncrasy to its use. In a large number of insane 
and hysterical cases De Montyel found its use was followed by vom- 
iting of part of the food, but the patients seemed to have no nausea. 

ELATERIUM. 

Elaterium, B. P., is a sediment obtained from the juice of the 
Ecballium Elaterium, or squirting cucumber. It appears in small, 



ERGOT. 179 

easily-broken, thin, grayish-green flakes, and has a bitter taste. Ela- 
teriurn is not official in the U. S. P., but its active principle, elaterin 
(Elaterinum, U. S. and B. P.), is official. Notwithstanding this fact, 
the crude drug is largely used. 

Physiological Action. — Elaterium is a very decided irritant to all 
mucous membranes, and even to the hands of those who handle it. 
Its chief effect in man is to cause profuse watery stools, but for some 
unknown reason it rarely acts upon animals in this manner. 

Therapeutics. — This drug is the best hydragogue purge which w T e 
have, causing very large watery passages, but not producing much 
pain when used in proper dose. For this reason it is useful in the 
treatment of local serous effusions, as in 'pericarditis and pleurisy, and 
in dropsy and ascites. It ought never to be used in cases of marked 
exhaustion, and may be advantageously followed, soon after it acts, 
by alcoholic stimulants. In urazmia with dropsy it is thought to aid 
in the elimination of the poison by the bowel. In cerebral conges- 
tions or effusions the drug will often be of service by depleting the 
diseased vessels. 

In poisoning by elaterium the symptoms are those of violent gas- 
troenteritis, and must be treated accordingly. (See Grastro-enteritis.) 

Administration. — The dose of elaterium is -J- of a grain (0.01), 
given in a freshly-made pill. Elaterin is best given in the dose of 
from ^ to ^ of a grain (0.002-0.004), as follows : 

R — Elaterini gr. iv (0.2). 

Alcoholis fjiv (128.0).— M. 

Dissolve by gentle heat. 
S. — Half a drachm contains ^t g ram (0.004), or one full dose. 

The official preparations of elaterin, the active principle of elate- 
rium, are Trituratio Elaterini, U. S. (elaterin 1, sugar of milk 9), 
given in the dose of \ to 1 grain (0.03-0.06), and Pulvis Elaterini 
Qompositus, B. P. (elaterin 1, sugar of milk 39), dose 1 to 5 grains 
(0.05-0.35). 

ERGOT. 

Ergota, JJ. S. and B. P., is derived from the spawn or mycelium of 
the fungus known as Claviceps Purpura, which grows in the flow T er 
and replaces the grain in common rye, or Secale Cereale. 

Many so-called active principles have been isolated by chemists, 
and named ecbolic acid, ergotic acid, sclerotinic acid, and ergotin. 
None of them represent the entire drug, the nearest in its approach 
being ergotin, and ergotin is not an isolated principle, but a combina- 
tion of principles. Kobert teaches that there are three principles — 
namely, ergotinic acid, cornutine, and sphacelinic acid, and that cor- 
nutine is a true alkaloid, Tanret, on the other hand, denies the 
existence of cornutine as an alkaloid. 

Physiological Action. — Nervous System. — Upon the nervous sys- 
tem ergot exercises little, if any, effect. In chronic poisoning, due 
to eating rye bread contaminated by ergot, we sometimes see what is 



180 DRUGS. 

known as spasmodic ergotism, due to disturbances of the nervous 
system. 

Circulation. — Ergot when injected into the circulation causes a 
primary fall of arterial pressure, followed by a rise. The dominant 
action is represented in the rise. This rise is due to a stimulation of 
the vasomotor centres, but the primary fall is caused by its direct 
depressant effect upon the heart-muscle, resulting from the direct 
contact of the drug en masse with the heart. 

If the dose be very large, the fall of pressure is never recovered 
from, and progressive paralysis of the vasomotor apparatus and heart 
occurs. 

Uterus and Unstriped Muscular Fiere. — It has been com- 
monly taught that ergot acts as a stimulant to the uterine muscle 
and causes contraction of unstriped muscular fibres everywhere, but 
the careful studies of Hemmeter have proved that the drug also 
causes uterine contractions by stimulating the centres in the lumbar 
portion of the spinal cord. 

On the uterus ergot in full medicinal dose exerts its influence — not 
increasing the normal pains of labor, but causing a tetanic, tonic, 
unyielding uterine spasm which drives all before it. In very small 
doses it may assist the normal contractions without causing them to 
become tetanic. 

Chronic Poisoning. — Two forms of poisoning from the prolonged 
use of ergotized rye bread sometimes occur. One is characterized by 
spasmodic muscular contractions, the other consists in the formation 
of gangrenous sloughs. 

Therapeutics. — Ergot is given to parturient women for the preven- 
tion or cure of post-par turn hemorrhages. For the prevention it should 
be given to the woman by the mouth just as the head of the child is 
about to slip over the perineum, and not before. When administered 
to stop a hemorrhage already flowing, the doses should be large, as 
much as 1 to 2 drachms (4.0-8.0) of the fluid extract or 2 wineglass- 
fuls (64.0) of the wine of ergot. Ergot should never be given in the 
early stages of labor, but this rule may, under certain conditions, be 
modified. If uterine inertia comes on in the course of a normal labor, 
and quinine cannot be used for any reason, a small dose of ergot may 
be employed. These small doses do not cause a constant tetanic 
uterine contraction, but simply bring on the " to-and-fro " move- 
ments. By small doses the writer means from 5 to 20 drops (0.35— 
1.3) of the fluid extract. 

If the canal is obstructed, ergot should never be employed, and, 
unless the os. uteri is well dilated, should not be given in any dose. 

In post-partum hemorrhage it may be well to give a solution of 
the aqueous extract of ergot hypodermically. The extract should be 
rubbed with the proper amount of water (parts 1 to 5), and filtered 
through a fine aseptic handkerchief to get rid of foreign bodies before 
it is injected. 

When ergot is given care should be taken that the uterine cavity be 
clear of all clots or placental fragments, lest the closure of the os uteri 
under the influence of the drug imprison these harmful materials. 



ERIGERON. 181 

According to many obstetricians, whose results have been con- 
firmed by a number of special studies, ergot very distinctly aids in 
overcoming subinvolution of the uterus. 

In hemorrhages from the lungs and kidneys or other unapproach- 
able parts ergot is thought by some to be very useful when given by 
the mouth, but it is probable that it rarely achieves any real good. 
Particularly is this the case in pulmonary hemorrhage, since the vaso- 
motor system practically does not exist in the pulmonary vessels, and 
the increased pressure caused by the ergot in the general systemic 
circulation may increase the pulmonary leakage. The truth is that 
in pulmonary hemorrhage very little real good can be obtained by 
internal medication. 

In epistaxis, menorrhagia, and metrorrhagia, and in some cases of 
night-sweats, it is of service. In hypostatic, pulmonary, and other 
congestions it is useful, particularly if employed with digitalis. 

In dysenteries with bloody stools and in serous diarrhoea ergot 
sometimes does good. 

Some persons suffer from vertigo associated with hyperesthesia of 
the scalp and headache. Relief can often be obtained by the use of 
20 drops (1.3) of the fluid extract of ergot and 5 to 10 grains (0.35- 
0.65) of bromide of potassium three times a day. 

Ergot has been used very largely in the treatment of uterine fibroids 
as an expulsive remedy and cure. It is only of value in those cases 
where the growths are just beneath the mucous membrane. By the 
■contractions of the uterine muscular fibres the blood-supply of the 
growth is decreased, the recurring hemorrhages cease, and the tumor 
is finally expelled, having really sloughed out of its bed. This method 
is inferior to the knife, and very painful and prolonged. Large 
growths cannot be so treated. Ergof is sometimes useful in the 
treatment of bleeding hemorrhoids, and it has been given with suc- 
cess in diabetes insipidus. 

Administration. — Ergot is official in the U. S. P. as the fluid extract 
(Extr actum Ergotce Fluidum), dose \ to 1 drachm (2.0-4.0); the solid 
extract (Extr actum Ergotce), dose 5 to 20 grains (0.35-1.3); and the 
wine (Vin urn Ergotce), dose 2 to 4 drachms (8.0-16.0). Bonjean's 
ergotin is made by a special process, and it or the solid extract can 
be given hypoclermically in the manner already described. The B. P. 
preparations are Extractum Ergota? Liquidum, dose 10 to 30 minims 
(0.65-2.0) ; Infusum Ergotce, 1 to 2 fluidounces (32.0-64.0) ; Tinctura 
Ergotce, 10 minims to 1 fluidrachm (0.65-4.0). Ergotin (Ergotinum, 
B. P.) is given in the dose of 2 to 5 grains (0.1-0.35). Injectio 
Ergotina Hypo dermic a, B. P. (ergotin 1, camphor-water 2 parts), is 
given, in the dose of 3 to 10 minims (0.15-0.65), by subcutaneous 
injection. 



ERIGERON, or PLEABANE. 

Oil of Erigeron (Oleum Erigerontis, U. S.) is a }~ellowish volatile 
oil of a peculiar, not bad, taste, closely resembling turpentine. It is 



182 DRUGS. 

by far the best remedy which we have for the treatment of passive 
uterine oozing, or a "show," as it is sometimes called. 

In epistaxis and other hemorrhages of a subacute type it is quite 
useful. In some instances it is used in place of copaiba and cubebs 
in the later stages of gonorrhoea. It is best given in capsule or on 
sugar in the dose of 10 to 30 drops (0.65-2.0) after meals, or oftener 
if needed. 

ETHER. 

Sulphuric ether is official as JEther, U. S. and B. P., but in the 
Pharmacopoeia of 1880 was called JEther Fortior. Pure Ether 
(dEther Purus, B. P.) is free from alcohol and water. Ordinary 
ether is not generally used as an anaesthetic, but for the abstraction 
of oils and for other pharmaceutical purposes. It is made by the 
action of sulphuric acid on ethylic alcohol, and is sometimes called, 
in consequence, ethyl oxide. Ordinary ether contains about 74 per 
cent, of ethyl oxide and 16 per cent, of alcohol, with a little water. 
On the other hand, the stronger or official ether contains about 96 
per cent, of ether oxide and only 4 per cent, of alcohol, with water. 
Both preparations boil when held in a test-tube if a piece of broken 
glass is added to the liquid. The stronger ether boils much more 
vigorously than the weaker under these circumstances. 

Ether possesses a peculiar penetrating odor, a hot burning taste, 
and is a colorless, volatile, and very inflammable liquid. For this 
reason it should never be held near a fire or light, and, as its vapor 
is heavier than air, any light in the room should be above the patient, 
not below him. No light should be held nearer than five feet. 

Physiological Action. — The action of ether on the animal organism 
is very rapid and powerful, but temporary. Except for the rapidity 
of its effects it is very much like that of alcohol. When applied to 
the skin, it causes intense cold by its evaporation, and may be used in 
the form of a spray to benumb or locally freeze a part. 

Upon mucous membranes ether acts as an irritant, and causes, 
when first inhaled, great irritation of the fauces and respiratory 
tract, so that temporary arrest of respiration is not uncommon. The 
face becomes suffused and red and the conjunctiva injected, but a stage 
of quiet succeeds the primary stage of struggling which arises from 
the choking sensations. During this period the breathing is gen- 
erally full and deep and the pulse rapid but strong, while the ocular 
reflexes are at its beginning intact. Following this stage a second 
period of struggling comes on, in which the patient may become 
absolutely uncontrollable except by brute force. Yelling, shouting, 
screaming, cursing, or laughing and crying, may be prominent symp- 
toms, and the individual is pugilistic, caressing, or ill-tempered, as 
the case may be. If the drug is now pushed, a condition of total 
anaesthesia is attained, and quietude takes the places of the struggles. 
This is the time for the operation to be carried on, for if it is attempted 
in the earlier stages the struggles of the- second stage prevent any 
operative procedures. (See Therapeutics below.) It is not proper to 



ETHER. 183 

push the muscular relaxation to complete flaccidity, as this endangers 
the respiration. 

Nervous System. — Ether acts first on the brain, then on the sen- 
sory centres of the spinal cord, then on the motor centres, then on 
the sensory centres of the medulla oblongata, and finally upon the 
motor centres of the medulla, thereby producing death from respira- 
tory failure. Upon the nerve-trunks it exerts no effect unless it is 
directly applied to them. Ether does not produce anaesthesia by 
influencing the blood, coagulating the protagon of the nervous sys- 
tem, or by any other destructive influence. It simply puts aside, for 
the time being, the vital functions of the parts affected by it. 

Circulation. — Ether is one of the most diffusible and rapid 
cardiac stimulants which we possess, and is correspondingly fleeting 
in its effects. It increases the pulse-rate and force by stimulating the 
heart and the arterial pressure by increasing the activity of the vaso- 
motor centres. In overdoses it acts as a cardiac depressant, but only 
when the amount is very large. 

Respiration. — When ether is first inhaled it often causes an 
arrest of respiration. According to Kretzschniar, this is due t6 an 
irritation of the trifacial nerve, which causes a reflex spasm of the 
glottis, and not to irritation of the peripheral vagi in the lungs. 
This is only partly true, for the author has proved that section of the 
vagus nerve prevents this occurrence, so that both the vagal and tri- 
geminal irritations are responsible for the arrest. 

Upon the respiratory centre ether acts as a powerful stimulant in 
ordinary amounts ; in overdose it paralyzes this part of the nervous 
system. 

Temperature. — Prolonged etherization lowers the bodily heat 
very greatly. That of the dog may be lowered some 9° F. in an 
hour if the drug be pushed, and as great a fall has been known as 
4° F. in man. The fall is partly due to the depression of the ner- 
vous system and the chilling of the body and lungs by the evaporation 
of the drug. 

Elimination. — Ether escapes from the body by the lungs and 
kidneys. 

Untoward Effects. — Ether, while safer than chloroform, is not 
absolutely devoid of all dangerous effects. Sometimes, when the 
drug is pushed too strongly, deep cyanosis with pulsation of the jug- 
ular veins shows deficient oxidation and cardiac distention. In other 
and very rare instances sudden cardiac failure has occurred or total 
arrest of respiration ensued. In nearly all cases of sudden death 
from ether grave kidney or other lesions have been present, and have 
been found at the autopsy. 

One of the earliest signs of the over-action of ether is the fail- 
ure of the diaphragmatic movement, followed by that of the lower 
part of the chest, then of the upper part, and then of the cervical 
muscles. 

In patients under ether the movement of the diaphragm is an 
exceedingly interesting study, for before the condition known as sur- 
gical anaesthesia is developed, while there is still some rigidity and 



184 DRUGS. 

the throat reflex is not completely abolished, the contractions of the 
diaphragm are frequently so violent that unless the laryngeal open- 
ing be absolutely free the intercostal spaces are depressed and the 
abdominal contents thrust violently downward and outward. Just so 
soon, however, as the chin is pulled forward and a free access of air 
is allowed, the abdominal displacement, though it is still present, is 
not so great, and the chest movement is no longer reversed. As the 
ether is pushed the respiration becomes purely thoracic, the dia- 
phragm no longer taking part in the respiratory cycle, or becoming 
so relaxed that it allows the chest on expansion to aspirate the 
abdominal viscera upward, as is shown by the retraction of the belly- 
walls at a time when they should normally expand with the thorax 
in inspiration. This observation would seem to point to the fact that 
the primary stimulant action of ether upon the respiratory apparatus 
is particularly felt by those centres which govern the movements of 
the diaphragm, and that, as this is the case, these centres later on 
are the first to feel the paralyzing effect of still larger amounts of 
the drug. 

These facts give us, therefore, yet another danger-signal during the 
administration of the ether, and the integrity of the diaphragmatic 
function, as represented by the movement of the belly-walls, should 
be as carefully observed as are the thoracic excursions, the character 
of the pulse, or the condition of the pupil. The rule may therefore 
be laid down that when the diaphragm ceases to act anaesthesia has 
been carried to its extreme legitimate limit, and that the use of an 
anaesthetic after this time must be carried on with the greatest care 
and watchfulness. 

The diaphragm is the first part of the respiratory mechanism to 
yield to respiratory paralysis. In death from any cause the progress 
of failure of respiration will, in the vast majority of cases, be denoted 
by a failure on the part of the diaphragm primarily, with compensa- 
tory excursions of the chest ; and it is also to be noted that as the 
chest movements fail the accessory muscles of the neck come into 
play. These muscles in time cease to act, the hyoidean group lose 
their point cVappui, the chest remains motionless, the lower jaw is 
dropped, and the scene is closed by a few gasps in which the muscles 
of the neck may be the chief factors. 

The treatment of accidents during etherization consists in the 
withdrawal of the ether, the use of artificial respiration, and the 
placing of the body, if the face is pale, head downward. On the 
other hand, if the face is flushed and cyanotic it indicates respiratory, 
not cardiac, failure, and this position is not to be resorted to. The 
physician should also employ hypodermic injections of strychnine, 
atropine, and digitalis, or, more rarely, an intravenous injection of 
ammonia, which is more dangerous, but better than the others in a 
pressing emergency because it is more rapid in its action. Ether is 
often given hypodermically under such circumstances, and seems to 
do good, but its use is a bad practice, as, if the heart or respiration is 
already depressed by ether, the employment of still more of the drug 
simply makes matters worse. The cases in which such a line of treat- 



ETHER. 185 

ment is followed by good results are those in which the failure of res- 
piration is not due to a saturation of the body with ether, but to 
asphyxia produced by mechanical interference with free breathing, as, 
for example, the presence of mucus in the air-passages or a too close 
application of the towel to the face. In such cases the hypodermic 
injection of ether causes so much local pain and irritation as reflexly 
to call up respiratory movements, as well as to directly stimulate the 
respiratory centre to greater effort. 1 Alcohol ought not to be used if 
the other drugs named can be obtained, because alcohol is so nearly 
allied physiologically and chemically to ether. Frictions, hot appli- 
cations, and artificial respiration should be practised. (See article on 
Asphyxia.) 

As ether is at hand, it may be dashed on the chest and abdomen 
to cause reflex inspiration, in lieu of cold water, which wets the 
clothes and does not evaporate rapidly. 

In some cases great nausea and vomiting follows the use of ether. 
This can generally be prevented by the proper use of food before the 
operation (see Therapeutics), and by the use of cracked ice and small 
doses of aconite or brandy after the operation. (See Vomiting.) Se- 
vere bronchitis may occur in invalids and children after the inhala- 
tion of ether. 

Therapeutics. — Ether is used chiefly as an anaesthetic by means of 
inhalation. The method consists in forming a cone out of a towel 
and a piece of paper and placing a small sponge in its end. Upon 
this sponge the ether is poured, and the large open mouth of the cone 
is placed over the face. If this be done suddenly, the sensation of 
suffocation is generally so great as to cause fright and struggling, 
which is inadvisable. The better way is to hold the cone at some dis- 
tance from the face, and gradually bring it nearer as the effects of the 
ether are felt. After partial anaesthesia is attained the cone should 
be placed closely over the face and the vapor be pushed in as concen- 
trated a form as possible, whereas when chloroform is used it should 
be well mixed with a great amount of air. Care should be taken 
that the ether does not get into the eyes of the patient, either in 
vapor or liquid form, owing to the irritation which it will set up. To 
prevent this a thin piece of muslin wet with water will be found of 
service if placed over the eyes. A large number of ether-inhalers 
are employed in preference to the towel, of which the best is probably 
that known as the " Allis Inhaler." 

When ether is to be given no food ought to be allowed the patient 
for twelve hours preceding its use, except a little milk or tea an hour 
or two before the operation, in order to avoid vomiting during and 
after this procedure. The patient should not be allowed to retain 
any tobacco or false teeth in the mouth, as either may slip into the 
larynx and cause death while the anaesthetic is being given. 

Locally, ether may be used in an atomizer spray as an anaesthetic, 
owing to the cold produced by its evaporation. Thus it is particu- 
larly useful in cases where thoracentesis or paracentesis abdominis is 

1 As consciousness is not necessary to the carrying out of a reflex action, this is per- 
fectly possible and probable. 



186 DRUGS. 

to be performed, and also in cases of superficial neuralgia, where the 
benumbing of the nerve often effects a permanent cure. 

Internally, by the stomach, ether is very useful in colic, although 
for flatulence of adults and children Hoifmann's anodyne is a more 
agreeable remedy. In cases of collapse the hypodermic and gastric 
use of ether makes it of great service when cardiac action is very 
feeble, and it will give relief by inhalation in some of these cases 
more rapidly than the nitrite of amyl. 

In hiccough a few inhalations of ether will often stop the spasmodic 
movements, and local muscular spasms can be relieved in this way. 

Ether may be used to produce muscular relaxation when the sur- 
geon attempts to reduce a strangulated hernia by taxis. 

In cases where cod-liver oil cannot be digested ether may be given 
in 20-drop (1.30) doses in ice-water or capsule, either with or some 
minutes after the oil is taken, to aid in its digestion and absorption. 
The time of its use should be that at which discomfort is apt to come- 
on, and not at any stated moment. 

Administration. — Ether should be given, when used internally, in 
ice-cold water, or, better still, in capsules, in the dose of 30 drops to 
J an ounce (2.0 : 16.0). If cold water is not used to dilute it, so great 
is the irritation of the fauces produced by the fumes of the ether that 
deglutition is impossible. 

Contraindications. — Ether should not be used by inhalation in 
bronchitis, acute nephritis, peritonitis, or gastritis, in aneurism, or in 
the presence of marked vascular atheroma. 



ETHYL BROMIDE. 

Bromide of Ethyl is obtained by distilling a mixture of alcohol, 
sulphuric acid, and bromide of potassium, and is a colorless fluid of 
neutral reaction, having a pleasant odor resembling chloroform. It 
evaporates with great rapidity, and any sample which does not do- 
this is to be discarded. Poured on the hand, it should leave no fatty 
feeling. It should be remembered that the drug is decomposed by 
sunlight and when in contact with pure air. In the presence of lamp- 
light the fumes form bromal hydrate and bromine. The drug should 
be kept in dark-glass bottles. The physician should distinctly sepa- 
rate in his mind bromide of ethyl from bromide of ethylene. The 
latter is a chemical product possessing very dangerous properties, and 
should never be used in medicine. There is reason to believe that 
unfavorable symptoms follow the use of bromide of ethyl only when 
the drug is impure or is improperly used. 

Physiological Action. — According to the studies of Thornton and 
Meixell in the Laboratory of the Jefferson Medical College, the domi- 
nant action of the bromide of ethyl is on the respiratory, not on the 
circulatory, system. This effect is depressant, but only seen after 
excessive doses. The blood-pressure falls under its influence to a 
slight degree, and the pulse is slowed through an influence probably 
exercised on the inhibitory nervous mechanism of the heart. 



ETHYL IODIDE. 187 

Therapeutics. — Bromide of ethyl is a useful anaesthetic for short 
operations, such as opening boils or abscesses, or for the relief of the 
pain in other brief surgical procedures. Originally introduced into 
general use in this country by Levis, it has been found unsuited to 
major surgical cases, because if continued for a long time it seriously 
depresses the respiration. Bromide of ethyl has been found of the 
greatest value by Montgomery of Philadelphia as an anaesthetic in 
labor and for minor gynecological operations in office practice. He 
finds that the patient may be allowed to inhale the drug from a Haw- 
ley inhaler, for as soon as she has had enough to produce anaesthesia 
the inhaler drops from her hand. The patient is also more obedient 
to the physician's directions, because of the fleeting influence of the 
drug, than when chloroform or ether is taken, and it is not so apt 
to cause post-partum hemorrhage through uterine relaxation. 

A very great advantage possessed by bromide of ethyl is the 
rapidity of its action. A few whiffs are generally all that is needed 
to cause anaesthesia. It rarely produces disagreeable effects. Cases 
of sudden death under its use are, however, on record, and in some 
instances nervous twitchings, and even tetanic spasms, have been 
known to follow its employment. These tetanic symptoms are, how- 
ever, fleeting and generally of little importance. Nausea and vomit- 
ing rarely follow its employment, but it is apt to leave an unpleasant 
garlic-like taste in the mouth, and a similar odor of the breath is 
frequently noted for several days after its use. 

Administration. — Bromide of ethyl should be administered but for 
a brief period, but when taken should be inhaled freely. It cannot 
be given carelessly with good effect. If a good sample is employed, 
45 minims to 3 drachms (3.0-12.0) is a sufficient amount. This quan- 
tity should be used at once, instead of added to the inhaler drop by 
drop, as in the case of chloroform, and the cloth or inhaler should be 
held close to the mouth and nose, instead of at a little distance, as is 
often necessary with other anaesthetics. 



ETHYL IODIDE. 

This is a colorless, non-inflammable liquid, which really should be 
called hydriodic ethyl. Ethyl iodide must be kept in dark-colored 
bottles in a dark place to prevent it from undergoing decomposition. 
It is very volatile, and the fumes arising from it are slightly pungent, 
but not irritating in ordinary amounts. Unfortunately, the odor is 
disagreeable to most persons. 

Physiological Action. — Very little is known of the general physio- 
logical action of iodide of ethyl, and the drug would be a good one 
for laboratory investigation. It does not produce anaesthesia except 
in very large amounts. 

Therapeutics. — Iodide of ethyl is used in medicine entirely by 
inhalation for the treatment of subacute or chronic catarrh of the air- 
passages and for the purpose of rapidly impressing the system with 
iodine for alterative purposes, as it is the iodine in the remedy which 



188 DRUGS. 

produces the curative effects desired. In catarrhal states of the bron- 
chial tubes the stimulating effect of the iodine is supposed to cause 
free secretion and to prevent abnormal thickening of the mucus and 
dilatation of the air-passages. For this reason iodide of ethyl is sup- 
posed to be of service in asthma and its resulting emphysema. Very 
recently Bartholow has recommended this drug in the treatment of 
pneumonia. It is said by that writer to be particularly useful in the 
later stages of this disease, as it aids in producing resolution, but the 
author has never seen it produce much effect. 

Administration. — 10 to 20 drops (0.65-1.3) may be placed upon a 
handkerchief and inhaled, or a small vial filled with the drug may be 
held in the hand under the nostrils. Under these circumstances the 
heat of the hand sets free the necessary amount of vapor. 



EUCALYPTUS. 

Eucalyptus, U. S., is the leaves of the Eucalyptus Globulus, or blue- 
gum tree, a native of Australia, but grown at present all over the 
world. Its chief medicinal constituent is the oil of eucalyptus (Oleum 
Eucalypti, U. 8.), from which is derived Eucalyptol, U. S., which is 
a camphorous body obtained by redistillation with caustic potash or 
chloride of calcium. The oil of eucalyptus and eucalyptol are used 
for the same purposes, but the latter is the refined product of the 
former. 

Physiological Action. — Locally applied, the oil is a decided irritant. 
10 to 20 drops (0.65-1.3) taken internally cause slight stimulation, fol- 
lowed by a sense of calm, while larger doses produce disturbed diges- 
tion and loose, oily-odored stools. The pulse is increased in frequency 
and force, and intense headache may come on. After very large 
doses there is a fall in pulse-force, bodily temperature, and strength 
of limb, and the respirations are decreased. A peculiar loss of sen- 
sation in the lower limbs may occur. If death takes place, it is due 
to respiratory failure. The drug is eliminated by the skin, kidneys, 
bowels, and lungs. The urine may have the odor of violets, as it 
sometimes does after the use of oil of turpentine. 

The oil of eucalyptus has considerable antiseptic power. 

Therapeutics. — Eucalyptus is used in malarial fever where quinine 
cannot be had, or be borne by the patient owing to idiosyncrasy. In 
bronchitis, in an emulsion or in capsule, it is of great value in the later 
stages (see Bronchitis), and it may be used in the subacute forms of 
gonorrhoea in the same manner, since in its elimination by the lungs 
it acts locally upon the inflamed mucous membrane. The following 
prescription will answer : 

R —Olei eucalypti f^j (4.0). 

Olei amygdalae dulc f^j (4.0). — M. 

Ft. in capsule No. x. 
S. — One t. d. after meals. 

Oil of eucalyptus is very useful in some forms of rheumatic head- 
ache or in headache dependent upon malarial fever. 



EUPHORBIA PILULIFEBA. 189 

Eucalyptol, U. S., is obtained from oil of eucalytus, and is largely 
employed by rhinologists and others in lotions and other nasal appli- 
cations It may be used in solutions of fatty oils, but is insoluble in 
water, although it is soluble in alcohol and ether. 

Administration. — The fluid extract (Extractum Eucalypti Fluidum y 
U. S.) is given in the dose of 10 drops to 2 drachms (8.0), the oil 
(Oleum Eucalypti, U. S. and B. P.) in the dose of 5 drops (0.35). 
The dose of eucalyptol is 5 grains (0.35) in capsule. 

Unguentum Eucalypti is official in the B. P., but is seldom used. 



BUONYMUS. 

Euonymus, U. S., or Wahoo, is the bark of Euonymus Atropurpu- 
reus, a native plant of the United States. It contains an active prin- 
ciple, Euonymin, B. P. As a laxative its action is very slow and 
moderate, but it is thought to act particularly on the liver, and may 
be used when mild hepatic torpor is present. 

Administration. — The dose of the solid extract (Extractum Euonymi, 
U. S., Extractum Euonymi Siccum) is 3 to 10 grains (0.15-0.65). Of 
euonymin the dose is J to 1 grain (0.03-0.05). 



BUPATORIUM. 

Eupatorium, U. S., Thoroughwort or Boneset, is the leaves of the 
Eupatorium Perfoliatum, an American plant which is very largely 
used as a simple bitter tonic and diaphoretic in household medicine. 
The drug is generally given in hot infusion in cases of arrested men- 
struation due to cold or in the chill of a remittent or intermittent fever, 
and also for anorexia and debility. Its taste is very disagreeable, and 
in the dose of a pint (500 cc.) of the cold infusion it has been used as 
an emetic. The fluid extract (Extractum Eupatorii Fluidum, U. S.). 
is given in the dose of 30 drops to 1 drachm (2.0-4.0). 



EUPHORBIA PILULIPERA. 

This herb is sometimes called Snake-weed or Cat's-hair, and is a 
native of Australia and the West Indies, where, like stramonium, it 
grows profusely as a weed by the wayside. 

Physiological Action. — In toxic doses the drug kills small ani- 
mals by failure of the respiration and circulation, these two vital 
functions being greatly affected by doses which exert no great influ- 
ence on the rest of the body. In full dose it may cause some gastric 
irritation. 

Therapeutics. — Euphorbia pilulifera is one of the latest remedies 
introduced into medicine for the relief and cure of asthma, in which 
disease the results obtained, after other remedies fail, are very extra- 



190 DRUGS. 

ordinary if the reports of those who have given it a thorough trial 
can be accepted without reserve. As yet we do not know the form 
of asthma which is most relieved by its use, and its employment is 
purely empirical. It has also been highly praised in the treatment 
of chronic bronchitis and emphysema. 

Administration. — Euphorbia pilulifera is best given in the form of 
the fluid extract in the dose of 30 drops to 1 drachm (2.0-4.0). The 
decoction is made by adding a " handful of stalks with the leaves on 
them to 2 quarts (2 litres) of boiling water, and boiling down to 1J 
quarts (1J litres)." Of this decoction the dose is a small wineglass- 
ful (64.0) three times a day. (See Asthma.) 



EUROPHEN. 

Europhen is the result of the action of iodine on isobutylorthocre- 
sol in the presence of an alkali, and appears as a fine yellow powder, 
soluble in alcohol, ether, chloroform, and oils, but insoluble in water. 
Introduced because it was hoped that it might prove a useful substi- 
tute for iodoform, its usefulness is still undecided, owing to the short 
time that it has been before the profession. One advantage claimed 
for it is that it parts with its iodine very slowly, and so is not apt to 
produce toxic symptoms as rapidly as does iodoform. For this very 
reason, however, it lacks the remedial power of the older drug, except 
in those instances in which a drying powder is needed which will 
keep the wound pure by making it too dry to be favorable to the 
growth of germs. When such an action is desired, europhen pos- 
sesses the additional advantage of being five times as bulky as iodo- 
form. In the treatment of tuberculous growths europhen has already 
proved itself very inferior to iodoform. Owing to its stability, it fails 
to part with its iodine except in the presence of moisture, and is use- 
less in dry skin diseases. It has been found useful in scrofuloderma 
ulcer of the legs, and lupus. Europhen may be employed externally 
in a salve of the strength of from 5 to 10 per cent., or with olive oil 
or lanolin. It can also be added to flexile collodion. The drug does 
not possess the odor of iodoform, but experience will probably prove 
it to be more irritating than the latter drug. The internal dose is 1 
to 3 grains (0.05-0.15) in cases of syphilis. Europhen is incompat- 
ible with metallic oxides and the preparations of mercury, and also 
with the starch and zinc paste largely used by dermatologists. 



EXALGINE. 

This substance is really methyl-acetanilid, and closely resembles 
acetanilid or antifebrin in its effects. It is given for the same pur- 
poses as is acetanilid and antipyrine — namely, for the relief of pain 
in locomotor ataxia and other nervous affections — but never as an 
antipyretic. When used, exalgine should be given night and morn- 
ing as a rule, so that the doses shall not be near together. The 



FLAXSEED. 191 

"beginning dose should be from 2 to 4 grains (0.1-0.2), and not more 
than 15 grains (1.0) should be given in twenty-four hours. It is 
stated by those who have used the drug that fever contraindicates its 
employment. 

The following prescriptions will be found applicable : 

R. — Exalgini _ gr. xxx (2.0). 

Tincturse aurant. dulcis f£ij (8.0). — M. 

Ft. in sol. et adde 

Syr. aurantii f^ss (16.0). 

Aquae menth. piperit q. s. ad f^iv (128.0). — M. 

S. — A tablespoonful night and morning. 

Or, 

R. — Exalgini - gr. xxx (2.0). 

Spt. frumenti f^ss (16.0).— M. 

Ft. in sol. et adde 

Syr. simplicis fjfj (32.0). 

Aquae dest . . . . q. s. ad fgiv (128.0).— M. 

S. — Tablespoonful night and morning. 



FLAXSEED. 

Flaxseed or Linseed {Linum, XT. S.) is the seed of Linum TJsita- 
tissimum, or flax from which linen is made ; it is official in the B. P. 
as Lini Semina. It contains an oil and a mucilage, the first of which 
is largely used in the arts, and the second is sometimes employed in 
medicine. The oil {Oleum Lini, U. S. and B. P.) is also used by 
physicians and pharmacists for various purposes. 

Therapeutics. — Flaxseed acts as a demulcent to inflamed mucous 
membranes, and is used largely in the treatment of acute cystitis, 
bronchitis, gastritis, nephritis, and similar states, in the form of flax- 
seed tea. This is prepared by mixing together 3 drachms (12.0) of 
flaxseed, not ground, 30 grains (2.0) of extract of liquorice, 10 ounces 
(320.0) of boiling water, and allowing the mixture to stand one to 
four hours in a warm place. If the mixture is boiled, the oil is set 
free and makes the dose disagreeable. This infusion may now be 
made more tasteful and useful by the addition of a little lemon-juice 
and sugar and by the placing of from 1 to 2 drachms (4.0-8.0) of 
gum arabic in the pitcher containing it. If the cough is excessive, 
a little paregoric may be added. Linseed oil is used sometimes as 
a laxative in the dose of 2 ounces (64.0), and is said to be of service 
when so given in the treatment of hemorrhoids. 

Flaxseed meal {Lini Farina, B. P.) is employed universally when 
moistened as a useful poultice. 

Under the name of Carron oil an emulsion of lime-water and lin- 
seed oil, equal parts, is the standard application for limited or exten- 
sive burns. 

An infusion of linseed {Infusum Lini) and a poultice {Cataplasma 
Lini) are official in the B. P. 



192 DRUGS. 

GALLIC ACID. 

Acidum G-allicum (U. S. and B. P.) is usually prepared from 
tannic acid. It occurs in nearly colorless, long, needle-like crystals, 
which are soluble in 100 parts of cold water, 4-| parts of alcohol, and 
3 parts of boiling water. 

Physiological Action. — Gallic acid is an astringent, but not a coag- 
ulator of blood. Locally applied in bleeding, it is useless, but given 
internally in hemorrhages which cannot be acted upon by the direct 
locally application of tannic acid, it is useful as a haemostatic. It is 
eliminated from the body by the kidneys as gallic acid. 

Therapeutics. — Gallic acid may be used with much success in hema- 
turia, haemoptysis, colliquative sweats, and in bronchorrhoea with pro- 
fuse expectoration. 

Combined with opium, it is one of the best remedies in diabetes 
insipidus, and is even useful in diabetes mellitus. 

In albuminuria dependent upon a relaxed, atonic state of the kid- 
neys and in acute or chronic diarrhoea gallic acid may be used with 
advantage. In the form of the ointment it is useful in the treatment 
of psoriasis, and in the cure of ulcers and sores which are actively 
discharging. A very useful application to external hemorrhoids is 
equal parts of stramonium ointment and gallic acid. 

Administration. — Gallic acid is given in the dose of 2 to 40 grains 
(0.1-2.6) in pill or solution. It ought never to be used with any salt 
of iron, as it is incompatible. The preparations used locally are 
Unguentum Acidi Gallici and Glycerinum Acidi Gallici, B. P., 
given in the dose of 10 to 60 minims (0.65-4.0). 

Nut-gall. 

Nut-galls (Galla, U. S. and B. P.) are the small excrescences found 
upon the oak (Quercus lusitanica) formed by the ova of the fly Cynips 
Gallm tinctorial. Their sole value depends upon the tannic acid con- 
tained in them, and they are official in the form of the tincture (Tinc- 
tura Gallm, U. S. and B. P.), dose \ to 2 fluidrachms (2.0-8.0), and 
the ointment (TJnguentum Gallm, U. S. and B. P.). Unguentum 
Gallm cum Opio is official in the B. P., and is used as an astringent 
and sedative ointment. 



GAULTHERIA. 

Wintergreen, or Gaultheria Procumbens, is an American ever- 
green containing a volatile oil. The oil possesses a peculiar, exceed- 
ingly penetrating odor and a warm aromatic taste. It is about 90 
per cent, salicylate of methyl. Salicylate of Methyl (Methyl Sali- 
cylates, U. S.) is an artificial product made official in the last revision 
of the U. S. P. 

Physiological Action.— Owing to the large amount of salicylate of 
methyl contained in the oil, its physiological action is almost identical 
with that of salicylic acid. 



GELSEMIUM. 193 

Therapeutics. — Aside from its use as a flavoring substance, oil of 
gaultheria is largely used in all forms of rheumatism and in place of 
the ordinary salicylates. It does not so commonly disturb the diges- 
tion of patients as do the salts of salicylic acid or the acid itself. 
The oil (Oleum Graultherice,U. S.) is best given in capsules or emul- 
sion or dropped on a teaspoonful of sugar three times a day after 
meals. The dose may be as high as 100 drops (7.0) a day; if 60 
drops (4.0) three times a day do no good, pushing it further is practi- 
cally useless. 

The spirit of gaultheria (Spiritus G-aultJierioe, U. S.) is given in 
the dose of 10 to 20 minims (0.65-1.3). 



GELSEMIUM. 

G-elsemium, U. S. and B. P., or Yellow Jasmine, as used in med- 
icine is the rhizome of the G-elsemium Sempervirens, a climbing plant 
of the Southern United States. It contains an alkaloid, gelsemine, 
and gelseminic acid. 

Physiological Action. — Nervous System. — Gelsemium paralyzes 
the spinal cord, particularly on its sensory side (?), although the motor 
side is certainly ultimately depressed. It does not influence the nerves 
or muscles except those of the head, on which it acts as a paralyzant, 
particularly affecting the motor fibres, 

Circulation. — Gelsemium is a depressant to the circulation, act- 
ing particularly on the heart. 

Respiration. — Gelsemium kills by paralyzing the respiratory cen- 
tres (Sanderson, Ringer, and Murrell). 

Temperature. — In overdose the drug lowers bodily heat very 
markedly. 

Eye. — Gelsemium is a mydriatic of considerable power, causing, 
when dropped into the eye, wide dilatation of the pupil, a result due 
to paralysis of the oculo-motor nerve. 

Therapeutics. — Gelsemium is used in headache and migraine depend- 
ing on nervous troubles or upon eye-strain. It is particularly useful 
in combination with cannabis indica. (See Cannabis Indica and 
Migraine.) 

In malarial fever it is said to be of great service, but this is doubt- 
ful. In the early stages of pneumonia and pleurisy it has been highly 
spoken of by Bartholow. 

Gelsemium has also been found of value in asthma, whooping 
cough, laryngismus stridulus, and nervous cough. In localized mus- 
cular spasm, such as seen in torticollis or wry-neck, and in spasmodic 
dysmeyiorrhjea, it is of considerable service. It ought not to be used 
if the system is already depressed, but only in sthenic cases. 

When used as a mydriatic, Tweedy recommends it as equal to atro- 
pine in effect, but much more transient in its influence. He uses a 
solution of 8 grains of gelsemine to the ounce (0.5 : 32.0) of water, 
instilled, drop by drop, into the eye every fifteen minutes for one 
hour, and then every half-hour for two hours. 

13 



194 DRUGS. 

Poisoning. — The most prominent symptoms of gelsemium poison- 
ing are ptosis and dropping of the jaw. These are preceded by a 
sensation of languor, a desire to lie down, relaxation, and muscular 
weakness. Gelsemium is apt to cause temporary internal squint, 
owing to its paralyzant action on the sixth pair of cranial nerves. 
The pulse becomes rapid and feeble, the skin wet and cold, the face 
pinched and anxious, the voice is lost in aphonia, and death ensues 
from centric respiratory failure and an almost simultaneous cardiac 
arrest. Sensation in man is impaired very late in the poisoning. 

' The treatment of the poisoning consists in the use of cardiac stimu- 
lants, such as ammonia, digitalis, and atropine, the application of 
external heat, and the employment of atropine and strychnine for the 
purpose of stimulating the respiratory centre. Emetics and the 
stomach-pump are, of course, to be employed. 

Administration. — The fluid extract (Extractum Gelsemii Fluidum, 
TJ. S.) is given in the dose of 5 to 10 minims (0.35-0.65), and the 
tincture (Tinctura Gelsemii, TJ. S. and B. P.) 10 to 20 drops (0.65-1.3). 
In some parts of the United States physicians largely employ a very 
strong unofficial tincture of gelsemium, the dose of which is 1 to 2 
drops. Gelsemine may be used in the dose of fa of a grain (0.001). 
Extractum Gelsemii Alcoholicum, B. P., is given in the dose of \ to 
J grain (0.008-0.015). 

GENTIAN. 

Gentiana, TJ. S., is the root of the Gentiana Lutea, or Yellow 
Gentian, a European plant. It contains gentianine and gentisic acid, 
and has a bitter taste. This drug is. official in the B. P. as G-entiance 
Radix. 

Therapeutics. — Gentian is one of the most efficacious bitter tonics 
that we possess, as well as one of the most elegant. In the anorexia 
following acute diseases and in gout and malarial poisoning with dys- 
pepsia it is of service. Combined with bicarbonate of sodium, it is of 
great service in the treatment of the gastric and intestinal catarrh of 
children. 

Administration. — The compound tincture {Tinctura Gentiance Com- 
posita, TJ. S. and B. P.) is given in the dose of 1 drachm to a wine- 
glassful (4.0-64.0), the fluid extract (Extractum Gentiance Fluidum, 
TJ. S.) in the dose of 30 drops to 1 drachm (2.0-4.0), and the solid 
extract (Extr actum Gentians, TJ. S. and B. P.) in the dose of 1 to 8 
grains (0.05-0.40). Infusum Gentiance Composition, B. P., is given 
in the dose of 1 to 2 fluidounces (32.0-64.0), and the compound tinc- 
ture (Tinctura Gentiance Compositus) in the dose of J to 1 fluidrachm 
(2.0-4.0). The compound tincture and infusion are composed of gen- 
tian, bitter orange-peel, and cardamoms. The following prescription 
is an excellent one for use in convalescence from prolonged fevers : 

R.— Acid, nitro-hydrochlor. dil f 7fi vel f^ij (4.0-8.0). 

Tr. nucis vomicae f^j (4.0). 

Tr. cardamomi corap f,^ij (64.0). 

Tr. gentianse comp q. s. ad f^iv (128.0). — M. 

S. — Teaspoonful (4.0) in water after meals. 



GLYCERIN. 195 



GERANIUM. 



Geranium, U. S., is the rhizome of Geranium Maculatum. It 
contains tannic and gallic acids, and is useful in diarrhoea as an astrin- 
gent. It is not the common red geranium seen in flower-gardens. 

In infantile diarrhoea geranium-root, boiled in milk in the propor- 
tion of one or two roots to the pint, will be found of great service 
and is tasteless. The dose of the drug itself is 20 to 60 grains (1.3- 
4.0), and that of the fluid extract (Extr actum Geranii Fluidum, 
U. S~) J to 1 fluidrachm (2.0-4.0). 



GINGER. 

Zingiber, U. S. and B. P., is the rhizome of Zingiber officinale, a 
plant of Hindostan, Jamaica, and other tropical countries. Black 
ginger is the dried rhizome with its bark, while white ginger has this 
covering removed. It contains a hot volatile oil and an aromatic 
resin, and is very largely used in domestic medicine as a carminative 
and stomachic. In the treatment of menstrual cramps it is often 
given, and is particularly useful in those cramps due to suppres- 
sion from exposure to cold. With purgative medicines ginger is 
employed for its flavor and the prevention of griping. Of itself it 
is decidedly constipating, and when used in diarrhoea mixtures is of 
value other than as a flavoring addition to the prescription. 

Administration. — The fluid extract (Extr actum Zingiberis Fluidum, 
U. S.) is given in the dose of 10 to 30 drops (0.65-2.0), well diluted; 
the tincture [Tinctura Zingiberis, U. S. and B. P.), dose 20 drops 
to 2 drachms (1.3-8.0); the syrup {Syrupus Zingiberis, U. S. and 
B. P.), dose 30 drops to 2 drachms (2.0-8.0); the oleoresin (Oleoresina 
Zingiberis, U. S.), dose ^ to 1 drop (0.03-0.05), well diluted or in 
pill; and the troches (Trochisci Zingiberis, U. S.) used as stimulants 
to salivary secretion. In the B. P. a stronger tincture, Tinctura 
Zingiberis Fortior, is official, dose 5 to 20 minims (0.35-1.30). 



GLYCERIN. 

Glycerinum, U. S. and B. P., is a liquid obtained by the decom- 
position and distillation of fats. It possesses great power of absorb- 
ing water and of dissolving many substances. Even if pure it irri- 
tates the skin of susceptible persons by its absorption of water, and 
often causes a slight rash. 

Physiological Action. — Injected into the circulation in large amounts, 
glycerin causes convulsions, which are due to its hygroscopic power. 

According to the clinical researches of Pavy, glycerin increases 
the polyuria of diabetes almost one-half, and for this reason he thinks 
it is not to be employed in this class of cases as a substitute for 
sugar. Again, the experiments of Luchsinger and Weiss have shown 
that the administration of this substance increases the amount of 



196 DRUGS. 

glycogen in the liver to a very considerable extent; while, on the 
other hand, the researches of Eckhard and Luchsinger have also 
proved that glycerin very frequently tends to prevent glycosuria 
which has been brought about by puncture of the so-called diabetic 
centre in the floor of the fourth ventricle, if the drug be given hypo- 
dermically. Luchsinger, therefore, believed that while glycerin 
might increase the amount of glycogen, it also prevented its trans- 
formation into sugar by inhibiting the amylolytic action of the 
hepatic ferment. Eckhard believes that the hypodermic injection of 
glycerin produces such radical changes in the blood and general sys- 
tem that no conclusion can be made of the proper influence exerted 
by it. In a paper exceedingly useful and interesting, both from a. 
physiological and clinical standpoint, Ransom of London has recently 
gone over this work in a satisfactory manner, and has tried, with con- 
siderable success, to unravel the somewhat complex pathology of the 
disease, as well as the equally complex and opposing statements of 
investigators as to the influence of glycerin. He points out that one 
element of fallacy in all these experiments is the fact that glycerin, 
when given hypodermically, must reach the liver so slowly and in 
such a diffused state as to be almost powerless, and, in consequence, 
Ransom introduced the glycerin into the alimentary canal. All the 
experiments seem to have been made in a most painstaking and care- 
ful manner, but, as we have no space for their detail, we must pass 
them by in order to reach the results attained. These are as follows : 
1. Certain forms of glycosuria may be checked by glycerin. 2. Gly- 
cerin acts more efficiently when introduced into the alimentary canal 
than when injected subcutaneously. 3. Glycerin checks glycosuria 
by inhibiting the formation of sugar in the liver. 4. By this means 
glycerin increases the quantity of glycogen found in the liver. While 
these conclusions are not final in proving the value of glycerin under 
such circumstances, it would seem probable that they are of great value 
in pointing toward a solution of one of the most complex subjects 
with which physicians are called upon to deal, and it is to be hoped 
that Ransom will publish other researches at a future time which will 
further elucidate this difficult subject. The quantity of glycerin 
which the writer would recommend to be given clinically by the 
mouth is 1 drachm (4.0) diluted at least one-half with water. 

Therapeutics. — Glycerin may be employed as a sweetening agent 
in the food of diabetics and in cases where sugar cannot be used. It 
has also been given as a laxative in 1- or 2-drachm (4.0-8.0) doses by 
the mouth, and in enema — 1 to 4 drachms (4.0-16.0) with or without 
equal parts of water. In some cases it may be used in suppository 
in the official Suppositoria Grtycerina, U. S. This latter method is- 
very successful in chronic constipation. Its continued use by sup- 
pository may, however, result in rectal irritation. 

As an antiseptic it is used for preserving specimens and for keep- 
ing alkaloids in solution for hypodermic use. 

In acute coryza, applied by a spray or brush to the nostrils, it is 
sometimes of service ; for this purpose it should be diluted four or 
five times with water. If used on the skin, it should be diluted one- 



GRINDELIA ROBUSTA. 197 

half with water. In cases of impacted cerumen in the external audi- 
tory canal glycerin is often of service in softening the mass. 

The uses of glycerin, other than those mentioned, are many. In 
the proportion of 1 part of glycerin and 1 of water it makes a very 
useful mouth-wash in the sore and dry mouth of typhoid fever and for 
the removal of sordes. The same wash, with lemon-juice added to it, 
is very agreeable and will relieve the dry, glazed tongue of advanced 
phthisis. 

Owing to the fact that glycerin is hygroscopic, it may be used as a 
depletant on a pledget of cotton in congestion of the uterine cervix, the 
tampon being renewed daily. (See Boric Acid and Boroglyceride.) 

For the prevention of bed-sores Ringer recommends the daily wash- 
ing and rubbing of the part likely to be affected, followed by the 
application of glycerin, and a draw-sheet placed smoothly against the 
patient to protect the bedding. 

Glycerin and whiskey is a favorite household remedy for colds and 
coughs, but is not very useful. Glycerite of starch {Glyceritum 
Amyli, JJ. S. and B. P.) is used as a protective. Glycerite of yolk 
of egg {Glyceritum Vitelli, JJ. S.) is used in making emulsions. 

A very useful ointment for the application of medicinal substances 
to the skin may be made by mixing constantly in the presence of heat 
1 part of potato starch and 15 parts of pure glycerin. The result is 
a clear, transparent, jelly-like substance which does not decompose, 
and has the advantage of holding the medicament which it carries in 
solution rather than by mechanical suspension. 

The B. P. preparations of glycerin are as follows : Glycerinum 
Acidi Carbolici, Glycerinum Acidi Gallici, Glycerinum Acidi Tannici, 
Glycerinum Aluminis, Grlycerinum Boracis, Grlycerinum Plumbi Sub- 
acetatis, and Glycerinum Tragacanthce. 



GOLD. 

Gold is not official in the JJ. S. Pharmacopoeia, but has been 
recommended very highly by Bartholow in chronic Bright' s disease in 
the form of the chloride of gold and sodium (Auri et Sodii Ohloridum, 
JJ. S.). The dose of this substance is -fa to ^ of a grain (0.003- 
0.006) once, tw T ice, or thrice a day. The author has not found it of 
much value. Gold has also been strongly recommended for indiges- 
tion with epigastric pain after eating w T hen looseness of the bowels is 
present, and it is said to act as a powerful sexual stimulant and to be 
of service in impotence dependent upon inability to obtain an erection 
or when there is deficient glandular action. In overdoses the drug- 
causes gastro-enteritis. Magruder has recommended chloride of gold 
and sodium in the treatment of pertussis. 



GRINDELIA ROBUSTA. 

Grindelia, JJ. S., is an American plant (Grindelia Robusta) con- 
a volatile oil, and an alkaloid. 



198 DRUGS. 

Physiological Action. — Upon the lower animals and man this drug 
is not very powerful in its action, but may cause, in large doses, 
paralysis of the peripheral sensory nerves, the sensory centres in the 
spinal cord, and finally the motor centres and nerve-trunks. It slows 
the heart by stimulating the vagi, and raises blood-pressure by stimu- 
lating the vasomotor centre. 

Therapeutics. — Grindelia robusta is an exceedingly useful remedy 
in some cases of asthma and in bronchitis in its later stages. It may 
be given in the dose of 20 to 60 drops (1.3-4.0) of the fluid extract 
(Extr actum Grindelice. Fluidum, U. S.), or by inhaling the fumes of 
burning grindelia-leaves, which are previously soaked in a solution 
of nitre, dried, and burned on a plate or rolled into a cigarette and 
smoked. In chronic cystitis it stimulates the bladder and is of great 
service. By diluting it 1 to 10 with water it forms one of the best 
lotions that we have for the relief of the dermatitis produced by poi- 
son ivy or Rhus Toxicodendron. 

Administration. — The only preparation which is official is the fluid 
extract (Extr actum Grindelia? Fluidum, U. S.), dose 20 to 60 drops 
(1.3-4.0). 

GUAIAC. 

Lignum Vitae, or Guaiacum Officinale, a West Indian tree, is used 
in medicine in two forms — namely, as guaiac wood (Guaiaci Lignum, 
U. S. and B. P.), which is in raspings and enters into the compound 
syrup of sarsaparilla, and guaiac resin (Guaiaci Resina, U. S. and 
B. P.), or guaiac, which is soluble in alcohol, ether, and chloroform, 
but insoluble in water. 

Therapeutics. — Guaiac has been largely used in syphilis, but is 
now rarely, if ever, so employed. Given in acute tonsillitis in the 
dose of 30 grains in an emulsion made by the use of white of egg, it 
will often abort the disease. In rheumatism it has been largely used. 
The ammoniated tincture of guaiac is sometimes employed in the 
treatment of sore throat, particularly if it be rheumatic in type, but 
is a disagreeable preparation to take into the mouth, and the sali- 
cylatis may always be used in its place. 

Administration. — The tincture (Tinctura Guaiaci, U. S.) is given 
in the dose of 5 to 60 drops (0.35-4.0), and the ammoniated tincture 
(Tinctura Guaiaci Ammoniata, U. S. and B. P.) is used in the same 
dose, preferably in milk. Mistura Guaiaci, B. P., is given in the 
dose of 1 to 2 fluidounces (32.0-64.0). 



GUAIACOL. 

Guaiacol is a liquid constituting from 60 to 90 per cent, of creo- 
sote. It is obtained by the distillation of beechwood creosote, fol- 
lowed by a complicated process which it is not necessary to describe. 
In other cases guaiacol is obtained from beechwood creosote by pre- 
cipitation with barium hydrate. Much of the "absolute guaiacol'* 



GUAIACOL. 199 

of commerce is impure. Chemically pure guaiacol, obtained by the 
process last named, is a light-colored fluid of an agreeable odor and 
soluble in water in the proportion of 1 to 85 (Helbing). It is easily 
soluble in alcohol and ether. 

Therapeutics. — Guaiacol has been largely used by some practition- 
ers, chiefly in Europe, for the treatment of tuberculosis as a substitute 
for creosote, because it is the principal ingredient of that drug. (See 
Creosote.) It was thought by Guttmann, Sommerbrodt, and others 
that the good effect of creosote was due to its destructive action on 
the bacillus, or that it so improved digestion as to increase the resist- 
ance of the patient to the spread of the disease. Recently, Hoelscher 
and Seifert have asserted that guaiacol and creosote produce their 
good effects by forming compounds with the toxines or poisonous 
albuminoids formed by the bacilli, which are then eliminated from 
the body. The same rules govern the use of guaiacol as govern the 
employment of creosote. It is best given with brandy, wine, or other 
alcoholic drink, or in capsules with cod-liver or sweet oil. 5 or 10 
drops (0.35-0.65) of guaiacol may be added to a pitcher of hot water 
and the vapor inhaled three or four times a day in cases of subacute 
and chronic bronchitis. The dose by the stomach is 5 to 20 minims 
(0.35-1.5). 

Recent clinical observations prove conclusively that guaiacol pos- 
sesses powerful antipyretic influences. As pointed out by Sciolla in 
1893, guaiacol when painted on the skin of a febrile patient causes a 
pronounced fall of temperature, which begins soon after the applica- 
tion is made, but is not fully accomplished for from two to three 
hours. The application may be made to the skin of the abdomen, 
thighs, or chest, about 30 to 40 drops (2.0-2.6) being used with a 
brush. When a full effect is required, it is well to place an imper- 
meable dressing over the part painted to prevent evaporation and aid 
absorption. These applications may be resorted to as often as is 
necessary for the reduction of the fever, and, although the fall of 
temperature is sometimes very rapid and very great — as much as 
7° F. in two hours — DaCosta has never seen serious nervous or car- 
diac symptoms produced, but other observers have noted such unto- 
ward results. The temperature is very apt to speedily rise after the 
reduction, and this rise is often preceded by a chill. These applica- 
tions are thought to be capable of supplanting the cold bath, and 
they undoubtedly do reduce the temperature. On the other hand, 
the cold bath, particularly when used in typhoid fever, exerts bene- 
ficial effects other than the mere reduction of temperature. The true 
sphere of usefulness for guaiacol as an antipyretic seems to be that 
of a less valuable therapeutic measure than the bath, and equally 
powerful and about as dangerous as the antipyretic drugs of coal-tar 
derivation. 

A serious objection to the external use of guaiacol is its disagree- 
able odor. When used externally in the fever of tuberculosis its 
action is very satisfactory, but the presence of cavities contraindi- 
cates its use, it is said. 

Probably future reports will develop the fact that in cases of renal 



200 DRUGS. 

irritation guaiacol will prove harmful. The studies of Stolzenberg 
show that if too frequently and constantly used guaiacol produces in 
febrile patients a tendency toward depression. Thayer finds that 
great sweating and depression generally follow its use in fevers. 

GURJUN OIL. 

Gurjun Oil, or, as it is sometimes called, Gurjun Balsam, or Wood 
Oil, is the exudation obtained, by incision and the application of 
heat, from the bark of an East Indian tree. It is a transparent 
liquid possessing the consistency of olive oil, of a greenish-gray color 
when held up to the light. It has an aromatic odor resembling to 
some extent that of copaiba. It is not, however, so disagreeable to 
the taste. 

Therapeutics. — Gurjun oil has been found of value in cases of 
chronic bronchitis where a stimulating expectorant of considerable 
power was desired, and this is particularly the case if the mucus in 
the bronchial tubes is very tenacious. The oil has also been found of 
value in gonorrhoea and gleet as a substitute for copaiba and cubebs. 

Administration. — Gurjun oil is best given in the dose of from 1 to 
2 drachms (4.0-8.0) three times a day, combined with spirit of nitrous 
ether, mucilage of acacia, and cinnamon-water, or mixed with extract 
of malt in the proportion of 2 drachms (8.0) of the oil to an ounce 
(32.0) of the extract. Persons having irritable stomachs may not 
be able to take this drug. 

HJEMATOXYLON. 

Hcematoxylon, U. S., Hcematoxyli Lignum, B. .P., or Logwood, is 
the heart-wood of Hcematoxylon Campechianum, a tree of the Amer- 
ican tropics. It contains an alkaloid, hematoxylin. 

Therapeutics. — Hsematoxylon is a mild astringent, very useful in 
serous diarrhoeas and in the diarrhoeas of young children, as children 
do not dislike it, owing to its agreeable taste. (See article on Diar- 
rhoea.). As it colors the stools and urine red, the nurse should be 
warned lest she be alarmed at the sight of what looks like blood on 
the diaper after the drug is given to infants. If the urine is alka- 
line, the color may be violet or red. In leucorrhwa its internal use is 
of service. The extract (Extractum Hamiatoxyli, U. S. and B. P.) 
is given in the dose of 8 to 30 grains (0.6-2.0), and Becoctum Hema- 
toxylin B. P. in the dose of 1 to 2 fluidounces (32.0-64.0). An 
unofficial fluid extract is often to be found in the shops. The dose of 
this is J to 2 fluidrachms (2.0-4.0). 

HAMAMBLIS. 

ffamamelis, XI. S., Witch-hazel, or Hamamelis Virginiana, is a 
plant of the United States, devoid of any true active principle, but 
possessing extraordinary remedial power. 



HOFFMAN'S ANOD YNE. 201 

Therapeutics. — Hamanielis is to be employed in relaxed sore throat 
resulting in congestion and hyperemia upon exposure, or where mild 
catarrhal states are present. Similarly, Ave employ it in an atomizer, 
after attacks of acute coryza, to tone up the nasal mucous membrane. 
The strength of the solution should be 20 to 60 1TL (1.3-4.0) to the 
ounce (32.0) of water. Hamamelis when taken internally is often 
wonderfully successful in the treatment of uterine oozing from small 
blood-vessels, seems to do good even in hcematemesis and haemoptysis, 
and will sometimes arrest hoematuria when all other remedies fail. 
Applied by means of cloths to leg ulcers, it acts very thoroughly and 
relieves the surrounding angry-looking skin at once. In bleeding 
from the bladder it may be injected into this viscus daily in the form 
of the distilled fluid extract. Taken internally and applied locally, 
it is of value in the treatment of bleeding and the so-called blind 
piles. (See Hemorrhoids.) 

Administration. — The one official preparation in the U. S. P. is the 
fluid extract (JExtractum Hamamelidis Fluidum, TJ. S. ; Liquidum, 
B. P.\ dose 5 to 20 drops (0.35-1.30). The dose of the distilled 
extract, which is not official and is a perfectly clear liquid, is from 
30 drops to 1 drachm (2.0-4.0), and this is much the best preparation 
for internal and external use. Unfortunately, the preparations of the 
drug vary very much both in odor and efficacy. Some of the pro- 
prietary preparations of witch-hazel are more active than those ordi- 
narily dispensed in the drug-store. This is due to greater care in 
their preparation, and to the fact that they are sold in original 
packages without exposure to the air. 



HOFFMANN'S ANODYNE. 

Spiritus JEtheris Compositus, ZT. S. and B. P., consists of alco- 
hol, ether, and the heavy oil of wine. The writer has experimentally 
studied very thoroughly the action of the last-named ingredient, and 
finds : 

First. That the belief in heavy oil of wine being the quieting 
agent in Hoffmann's anodyne is fallacious. 

Second. The calmative effects of this mixture depend largely on 
the ether, rather than on the oil. 

Third. It would seem probable that in Hoffmann's anodyne we 
possess an agent in which there are linked together three drugs of 
undoubted power, each one of which successively substitutes the 
other, stimulating the system in the order here named — viz. ether, 
alcohol, and the heavy oil of wine. 

On animal temperature, as ascertained by the thermometer in the 
rectum, the heavy oil of wine exercises no influence, even when the 
arterial pressure is very low. That large doses of the heavy oil of 
wine are in no way possessed of toxic effects is proved by the fact 
that 30 cc. of the drug, given by the mouth to a small dog weighing 
twelve pounds, failed to produce any apparent symptoms, except, 
perhaps, to stimulate him slightly. While the odor of the oil is 



202 DRUGS. 

penetrating, it is by no means disagreeable, and it possesses but 
little taste other than that caused by the presence of an oily sub- 
stance. 

Therapeutics. — Hoffmann's anodyne is the best carminative that 
we possess for general use, and is one of the best remedies for singultus 
or hiccough. These effects are accomplished probably in two ways : 
The alcohol and ether act as irritants or stimulants to the intestine, 
and free peristalsis results, while the heavy oil of wine acts, perhaps, 
as a nervous sedative. In angina pectoris this drug is often the best 
remedy we have, and in the cardiac palpitation of tobacco heart or 
that arising from indigestion it is very useful. 

In the nausea and depression seen after excessive smoking, Hoff- 
mann's anodyne should always be given in capsules or in cold water, 
preferably ice-cold, in order to prevent too rapid volatilization of the 
ether and consequent difficulty in swallowing the liquid. 

The dose is 1 to 2 drachms (4.0-8.0) to an adult. 



HOMATROPINE. 

Homatropine is an artificial alkaloid obtained by prolonged and 
gentle heating of a solution of equivalent quantities of tropine 1 and 
toluic acid in hydrochloric acid. The hydrobromate of homatropine 
(Homatropince Hydrobromas, B. P.) is a crystallizable salt of hom- 
atropine soluble in 10 parts of distilled water. 

Hydrobromate of homatropine, properly applied by frequent instil- 
lations, is a reliable mydriatic for the correction of anomalies of refrac- 
tion in healthy eyes. Experience is not at hand to determine its value 
for this purpose in eyes affected with retinal-choroidal disturbance. 
Atropine and hyoscyamine are preferred under such circumstances, 
for the obvious reason that their prolonged action is desirable as a 
method of treatment. The danger of systemic disturbance from hom- 
atropine is far removed, even when repeated instillations have been 
made, and its temporary action upon the pulse causes no inconvenience 
to the patient. Slight hyperemia of the conjunctiva almost invaria- 
bly follow its use, but true conjunctivitis, if it occurs at all, must be 
excessively rare. According to the studies of Dr. de Schweinitz and 
the writer, the drug has a physiological action closely allied to that of 
atropine, from which it is derived. Homatropine mydriasis generally 
lasts from thirty-six to forty-eight hours, that of hyoscyamine eight 
to nine days, and that of atropine ten to twelve days. For the pro- 
duction of ordinary mydriasis the drug should be used in solution of 
the strength of 4 grains (0.20) to the ounce (32.0) of distilled water, 
which is to be dropped into the eye every five or ten minutes. As 
the drug is expensive, only a few drachms of the solution of the 
strength named should be ordered for a patient. 

1 Tropine is a product obtained by splitting up atropine into tropine and tropic 
acid. 



HOPS. 203 



HONEY. 



Honey, or Mel, TJ. S. and B. P., is the saccharine fluid deposited 
in combs by the honey-bee, or Apis Mellifica. It is used to cover the 
taste of disagreeable medicines. When it is abstracted from a pecu- 
liar variety of flowers, it frequently has the odor of the flower, and 
when taken internally may even produce the physiological effects of 
the plant from which it is gathered. This accident occurs commonly 
in those parts of the country where the bees have had access to moun- 
tain laurel and similar plants. 

Therapeutics. — Honey is used as an emollient in gargles and to 
relieve cough and dryness of the mouth and fauces. When used as a 
gargle it very distinctly increases the secretion of the mucous mem- 
brane, and so relieves the congestion. 

Under the name of Oxymel the B. P. recognizes a mixture of 8 
parts of honey, 1 of acetic acid, and 1 of water. This is generally 
used as a vehicle for more active remedies in gargles or even for 
expectorant mixtures. Melted and strained honey is known as Mel 
Despumatum, TJ. S., and Mel Depuratum, B. P. There are also a 
honey of roses (Mel Rosce, TJ. S.) and a confection (Confectio Rosce, 
TJ. S.), used as vehicles for other drugs. 



HOPS. 

Humidus, TJ. S., is the strobiles of ordinary hops, or Humulus 
Lupulus. They contain a liquid volatile alkaloid, lupuline, and a 
bitter principle, lupulinic acid. Hops are known under the name of 
Lupulus in the B. P. Much confusion has arisen in regard to the 
preparations of this drug, partly because Humulus is the official name 
in the TJ. S. P. and Lupulus in the B. P. This has been increased 
by the fact that the alkaloid of hops is called lupuline, while the 
powder which is found on the strobiles is called lupulin. Those 
preparations in the TJ. S. P. having the word " humulus " in their 
name are made from the hops themselves, those with "lupulin" in 
their name from the powder of the strobiles. 

Therapeutics. — Hops are used as antispasmodics and nervous seda- 
tives in cases of hysteria and nervousness. In priapism, vesical irrita- 
bility, and renal irritation they are of service. Even in delirium 
tremens they seem to be of value. For local application a hop poul- 
tice may be made by placing the powdered strobiles in the mass, and 
employed in this way they are a favorite home remedy for local pain- 
ful inflammations. Hops have been used in the form of a hop pillow 
in nervous insomnia, but the soporific influence is largely imaginary 
or depends on the fumes of the alcohol with which the pillow is 
moistened. 

Administration. — The tincture (Tinctura Humuli,U. S.) is given 
in the dose of ^ to 3 ounces (16.0-96.0). Lupulin (Lupulinum, TJ. S. 
and B. P.), which is the powder found on the strobiles of hops, is 
given in the dose of 2* to 5 grains (0.1-0.35) or more; the oleoresin 



204 DRUGS. 

of lupulin {Oleoresina Lupulini, IT. S.) is given in dose of 10 to 40 
drops (0,65-2.65) in capsules; and the fluid extract (Extr actum Lupu- 
lini Fluidum, IT. S.), in the dose of 30 to 120 drops (2.0-8.0). The 
preparations of the B. P. are the extract of hops {Extr actum Lupuli), 
dose 5 to 10 grains (0.35-0.65); the infusion {Infusum Lupuli), dose 
1 to 2 fluidounces (32.0-64.0); and the tincture {Tinctura Lupuli), 
dose i to 2 fluidrachms (2.0-8.0). 



HOPE'S CAMPHOR MIXTURE. 

This is a mixture originally made with nitrous acid, but largely 
used at present with nitric acid, owing to the fact that nitrous acid 
is changed into nitric acid when water is added to it. The nitrous 
acid is, however, more efficacious than nitric acid in the serous or 
choleraic diarrhoeas which it is used to combat. The formula is as 
follows : 

R.— Acidi nitrosi f^j (4.0). 

Aquse camphorse f^ viij (256.0). 

Et adde 

Tinct. opii gtt, xl (2.65).— M. 

S. — One-fourth of this in water every three or four hours. 



HYDRASTIS. 

Hydrastis, IT. S., is the rhizome of the Hydrastis Canadensis, con- 
taining two alkaloids, known as hydrastine and berberine, and, per- 
haps, xanthopuccin. , 

Physiological Action. — In poisonous doses hydrastis may cause con- 
vulsions followed by paralysis, according to the quantity of berberine 
or hydrastine present. The latter is more' convulsive in its effects 
than the former. Upon the circulation hydrastine, when injected into 
the jugular vein, causes a primary fall of arterial pressure, succeeded 
by a decided rise, and the studies of Cerna have proved that it is an 
active poison producing spinal convulsions followed by paralysis. 

Therapeutics. — Hydrastis is of service in chronic g astro-intestinal 
catarrh, particularly that following the abuse of alcohol, and may be 
used as a stomachic and tonic after malarial fever and similar depress- 
ing diseases. Wherever membranes exist in a condition of lowered 
tone this drug is indicated. Thus in catarrhal jaundice of a subacute 
type, in uterine catarrh, in leucorrhoea dependent upon a relaxed state 
of the vagina, and in chronic nasal inflammations and irritations it 
will be found useful. 

Tincture of hydrastis is said to possess a distinct antimalarial 
influence. 

One of the best remedial measures that we have in the later stages 
of gonorrhoea, when the acute period has passed, is the local and 
internal use of hydrastis. If it is used as an injection, 5 grains 
(0 3) of the commercial hydrastine to each ounce (32.0) of water 
should be employed twice a day. If this is not used, the following 



HYDROCHLORIC ACID. 205 

infusion will be found of service : Take 1 drachm of the powdered 
root and add it to 8 ounces of boiling water ; J to 1 drachm of the 
fluid extract may also be added to a pint of water and used as a wash 
in vaginal gonorrhoea and leucorrhosa. In chronic dyspepsia hydrastis 
seems to act as an antiseptic and as a curative agent upon the mucous 
membranes of the stomach. 

Administration. — The fluid extract (Extractum Hydrastis Fluidum, 
U. S. ; Liquidnm, B. P.) may be given in the dose of 5 to 30 drops 
(0.30-2=0), while the dose of the tincture (Tinctur a Hydrastis, U. S.) 
is from 30 drops to 2 drachms (2.0-8.0). The Grlyceritum Hydrastis, 
U. S., is used as a healing application to mucous membranes. 

Much doubt exists as to the dose of hydrastine. This arises from 
the fact that two forms of it are sold. The most commonly seen is 
a dark-brown mass which is very impure, and contains berberine and 
other substances. Its dose is 3 to 10 grains (0.15-0.65). The pure 
hydrastine, as made by Merck, is given in the dose of \ to ^ grain 
(0.016-0.03). Hydrastinine hydrochlorate, an artificial alkaloid of 
hydrastine, has become official in the U. S. P. of 1890. 



HYDROBROMIC ACID. 

(See Bromides.) 

HYDROCHLORIC ACID. 

Acidum Hydrochloricum ( U. S. and B. P.) is a clear, colorless 
liquid, possessing an acid odor and taste, devoid of astringency, but 
in concentrated form decidedly caustic. It should be kept in dark- 
colored bottles. In the strength of two-tenths of 1 per cent, it is 
present normally in the gastric juice, and aids the pepsin in the con- 
version of proteids into peptones and in the formation of pepsin from 
pepsinogen. 

Therapeutics. — In dyspepsia due to faulty gastric secretion, as in 
typhoid fever, and in gastric indigestion accompanied with fermenta- 
tion, this acid is of service. In combination with compound tincture 
of cardamoms it is of value in intestinal indigestion. (See Indiges- 
tion.) The acid is best used in the form of the official dilute acid 
[Acidum Hydj^ochloricum Bilutum, U. S. and B. P.), dose 10 to 30 
drops (0.65-2.0) in water. 

In the sick stomach and gastric distress following an alcoholic 
debauch 20 drops (1.3) of the dilute acid in water are often of 
service. 

This acid is combined with nitric acid to form dilute nitro-hydro- 
chloric acid (Acidum Nitro-hydrochloricum Bilutum, U. S. and B. P.), 
the dose of which is 10 to 30 minims (0.65-2.0); also the pure acid 
(Acidum Nitro-hydrochloricum, U. S.), dose 1 to 5 minims (0.05-0.35). 

Hydrochloric acid causes, when taken in poisonous doses, violent 
g astro-enteritis and corrosion of the gastric walls, and its action should 
be combated by alkalies, soap, oils, and white of egg. 



206 DRUGS. 

HYDROCYANIC ACID. 

Hydrocyanic or Prussic Acid is a transparent, colorless, very vol- 
atile liquid, giving rise to vertigo when inhaled in minute amounts 
and producing death if the fumes be concentrated. If the bottle 
containing the pure drug be opened, it should be done where there 
is sufficient draught between windows to prevent any contamination 
of the atmosphere of the room by the acid. 

Pure hydrocyanic acid is never used in medicine ; the form 
employed is that of the dilute acid (Acidum Hydrocyanicum Dilu- 
tum, TJ. S. and B. P.), which contains about 2 per cent, of the drug. 
It must be kept in dark, tightly-stoppered bottles. 

Physiological Action. — This is one of the most rapid (if not the 
most rapid) lethal poisons known, only being approached by carbolic 
acid and nitrobenzole in the violence of its effects. Owing to its 
volatility, it is absorbed with great rapidity, and acts upon the respi- 
ratory centre and the heart, being eliminated almost immediately 
afterward. As a consequence, the survival of a patient twenty or 
thirty minutes after the ingestion of a poisonous dose is a favorable 
sign. 

The drug is an active paralyzant and exerts a lethal influence over 
every part of the body. The nervous system, heart, respiration, 
brain, and all vital parts are killed at once if much of it is present. 

Poisoning. — Death either comes at once, so that the person drops 
dead to the floor with a gasp, is for a moment convulsed, the face 
cyanotic, the eyes wide open, with the teeth tightly shut, and the 
lips covered by a bloody froth, or three stages of poisoning may 
ensue if the dose has not been very large. In the first of these there 
is difficult respiration, slow cardiac action, and disturbed cerebration. 
In the second stage, which is convulsive, we find wild cries, dilated 
pupils, unconsciousness, vomiting, spasmodic urination and defecation, 
erections of the penis, and ejaculations of semen. In the third stage 
there is asphyxia, collapse, and paralysis, ending in death. The 
blood is found to be dark and venous-looking, but does not give the 
spectrum bands of cyano-haemoglobin. These bands only appear 
when the drug is shaken with the blood outside the body. 

The diagnostic signs of death from prussic acid are the odor on 
the body, the wide-staring eye, the clinched teeth covered with froth, 
and the livid, cyanosed face. If the body be opened, the odor of 
hydrocyanic acid is marked, but rapidly passes away. 

The only poisoning producing symptoms resembling those which 
have just been described is that produced by nitrobenzole or essence 
of mirbane, which has a somewhat similar odor, but which is, how- 
ever, more permanent, the odor remaining in the opened body for 
hours. 

Therapeutics. — Hydrocyanic acid is useful in cases of gastralgia 
of purely nervous origin, and in some cases of nervous vomiting, and 
in irritable stomach where, owing to a hyperesthesia of the mucous 
membranes, the taking of food produces discomfort. 

In irritable coughs, due to tickling in the throat and bronchi, it is 



HYDROGEN PEROXIDE. 207 

very extensively used, and has received high praise by those best 
qualified to judge. On the other hand, it has been claimed that 
owing to the extreme volatility of the drug it only acts for the moment, 
and that a dose every ten or fifteen minutes is necessary to produce 
any real effect. However this may be in theory, practically the acid 
certainly does aid in relieving cough. In these states the following 
prescription will be found of service: 

R .— Acid, hydrocyan. dil f ^j (4.0). 

Morphinse sulph gr. ij (0.1). 

Syrup, pruni virg fjiij (96.0). — M. 

S. — Teaspoonful (4.0) every four or five hours to an adult. 

In enteralgia or neuralgia of the intestines dilute prussic acid is 
very useful. 

Externally, the drug is useful in pruritus and other forms of itch- 
ing skin diseases, and the following formula will be found of service 
in pruritus vulvae: 

R. — Hydrarg. chlor. corros gr. jss (0.09). 

Acid, hydrocyanic, dil f ,5j (4.0). 

Aquse araygdal. amarse f Jyj (192.0). — M. 

S. — Apply to the itching surface with a small rag. 

The same prescription may also be employed in pruritus without 
the bichloride, if so desired. The dose of dilute hydrocyanic acid is 
1 to 5 drops (0.05-0.35). In certain forms of irritable cough inhala- 
tions of the vapor ( Vapor Acidi Hydrocyanici, B. P.) are recom- 
mended ; these are prepared by adding 10 to 15 minims (0.65-1.0) of 
the diluted acid to 1 fluidrachm (4.0) of water, which is then placed 
in a suitable apparatus from which is inhaled the vapor that arises. 



HYDROGEN PEROXIDE. 

Peroxide of Hydrogen is a clear, odorless, syrupy fluid of a specific 
gravity of 1.452, possessing a harsh, bitter taste. It is readily sol- 
uble in water, and its chemical formula is H 2 2 . Pure peroxide of 
hydrogen is never used in medicine, but in solutions of varying 
strength. The ordinary solution, as found in the shops and that now 
official (Aqua Hydrogenii Dioxidi, U. S.), is about 3 per cent., or, as it 
is generally called, a 10-volume solution. This term, " 10 volumes," 
signifies that it can yield 10 volumes of available oxygen ; and it is 
upon this yield of oxygen that its activity depends. The specific 
gravity of this official solution is 1.006 to 1.012 at 59°. The reaction 
is acid, but this is due to a small amount of acid added to the solution 
to preserve it. The official solution of peroxide of hydrogen, while 
the most stable that can be prepared, is nevertheless readily deterio- 
rated by exposure to heat, sunlight, or prolonged shaking. If placed 
in an absolutely clean, smooth glass vessel, it may be concentrated for 
immediate use by exposing it to a temperature of 140° F. ; but 
exposure to a temperature above this point may result in its decompo- 
sition with explosive violence. Practically, this means of concentra- 



208 DRUGS. 

tion is not convenient for the practitioner, and the ordinary official 
solution fulfils all ordinary requirements unless it has deteriorated by 
age. The great difficulty in the use of the solution of the peroxide 
is its liability to undergo change and become practically worthless. 
Wallian states that as a rough test for the value of a given solution a 
few crystals of permanganate of potassium may be placed in a test- 
tube, and 1 or 2 drachms (4.0-8.0) of the solution added. The vio- 
lence of the resulting effervescence is in direct ratio to its value as 
a remedial agent. 

Therapeutics. — The most valuable use of the peroxide-of-hydrogen 
solution in medicine is in the treatment of diphtheria. So far as we 
know, it is the best application for the destruction and removal of the 
false membrane. There is no injury to the normal tissues, nor the 
danger of poisoning which sometimes follows the use of such drugs 
as carbolic acid. Applied to the false membrane, there is at once an 
active effervescence with some local tingling of the part. The mem- 
brane can afterward be removed in shreds. The solution should 
be applied by means of a swab or spray, but if the latter is used a 
glass atomizer must be used, as the peroxide is decomposed by coming 
in contact with metals. 

In the treatment of abscess-cavities, tubercular or septic in cha- 
racter, the peroxide of hydrogen is a very valuable application, and 
its use will often decide the presence of pus, since when it meets with 
this material active effervescence ensues. Similarly, it is a valuable 
preparation for cleansing ulcers and malignant growths which have 
ulcerated. The employment of the peroxide internally, with the idea 
that it will yield oxygen to the body in cases where this gas is lack- 
ing, is futile. Even if the oxygen entered the blood, the amount 
disengaged from a possible dose would be too small to be of any 
value. 

Where the peroxide is used as a gargle it may produce pain through 
its attacking cavities in the teeth or the metallic substances with which 
they are rilled. Taken internally, the peroxide of hydrogen is not 
poisonous. 

The internal dose of the Aqua Hydrogenii Dioxidi of the TJ. S. P. 
is from 1 to 4 drachms (4.0-16.0), well diluted with water, and taken 
from a porcelain, not a metal, cup or spoon. 



HYOSCYAMUS. 

Hyoscyamus, TJ. S., or Henbane, is a plant of the Northern United 
States and Europe. The leaves (Hyoscyami Folia, B. P.) only are 
used, and from them are obtained two alkaloids — one known as hyos- 
cyamine, the other as hyoscine. The first has the same physiological 
action as atropine. (See Belladonna.) The second is quite different in 
its influence over the body. The only marked difference in the action 
of hyoscyamine and atropine is in the mydriasis produced by each. 
While that of atropine lasts, in man. from twelve to fourteen days, 
hyoscyamine generally remains for only seven to nine days. Some- 



HYOSCYAMUS. 209 

times the development of mydriasis is preceded by violent pain in the 
eye due to cramp of the ciliary muscle. If so, the drug must be pushed 
to overcome the spasm. The strength of the solution to be used is 2 
grains (0.1) to the ounce (32.0). Owing to the presence of hyoscine 
in hyoscyamus, it is more quieting and depressing to the nervous sys- 
tem than is belladonna. 

Therapeutics. — Hyoscyamus is used in every condition indicating 
the employment of belladonna ; or, in other words, wherever local 
spasm or arterial relaxation exists or where pain is due to spasm. 
It has been particularly recommended in nervous cough, in whooping 
cough, and in colic, and probably is better in its influences in these 
states than is belladonna. In combination with nitrate of silver the 
extract may be used with advantage in chronic gastric catarrh. In 
urinary incontinence due to irritable bladder it is very serviceable, and 
particularly is this true of this affection in children and old persons. 

Administration. — The drug itself is official in four forms and as 
hyoscyamine sulphate and hydrobromate. The dose of the tincture 
(Tinctura Hyoscyami, U. S. and B. P.) is 30 drops to 1 drachm 
(2.0-4.0); the alcoholic extract (Bxtr actum Hyoscyami, U. S. and 
B. P.), dose 1 to 3 grains (0.05-0.15); the alkaloid (Tlyoscy aminos 
Sulphas vel Hydrobromas, U. $.), dose -fa to -fa of a grain (0.001- 
0.0015); and the fluid extract (Extr actum Hyoscyami Fluidum, 
U. S.), dose 5 to 30 drops (0.35-2.0). The B. P. preparation, 
besides those given, is the juice (Suceus Hyoscyami), dose 30 minims 
to 1 fluidrachm (2.0-4.0). 

Hyoscine. 

This is one of the alkaloids derived from hyoscyamus, and is a 
powerful nervous depressant. 

Physiological Action. — Hyoscine quiets the cerebrum and produces 
deep sleep in a certain class of patients. In the lower animals or in 
man it may cause sleep or wild delirium. It causes loss of reflex 
action in overdose, which is due to paralysis of the spinal cord and 
not of the nerve-trunks. Upon the circulation it has little effect, but 
it is worthy of note that it does influence the vagus nerves, as does 
atropine, stimulating them at first, and finally paralyzing them, 
although the contrary has been asserted. In any event, the circu- 
latory effect is a minor one. In cases where hyoscine has acted in 
excess, or where an overdose has been given, pilocarpine may be used 
as a physiological antidote in full doses. 

Therapeutics. — Hyoscine is of value as a hypnotic in a very lim- 
ited class of cases, but in this class generally acts most favorably. 
These cases consist of those who, from acute mania, alcoholic mania, 
hysteria, or similar cause, suffer from insomnia, and perhaps use vio- 
lent struggles against proper control or refuse to swallow or retain 
food. 

The drug may be given to such persons, hypodermically, in the 
dose of y^-Q to -g- 1 ^- of a grain (0.0006), or by the mouth in the dose 
of -fa to -fa of a grain (0.0008). The fact that it possesses no 
taste and is small in bulk renders it readily employed. In some 

14 



210 DRUGS. 

persons it utterly fails even in this particular type of cases. 1 In 
delirium tremens it may cause evidences of cerebral congestion 
and Cheyne-Stokes breathing. Some cases are not quieted by the 
drug, but pace up and down in a semi-sane condition until its action 
wears off. In the opinion of the writer the applicability of the drug 
is very limited indeed, and untoward effects are common. 

Hyoscine is certainly of great value in spermatorrhoea and noc- 
turnal emissions. 

The drug is contraindicated in the sore throat of scarlet fever, as 
it may cause glottic spasm. In the insomnia of heart disease with 
nervousness it will cause sleep, but may also produce death by respi- 
ratory failure or cardiac arrest, and it is to be remembered that the 
drug will produce asthma rather than relieve it. The breathing in 
some persons may become under its influence croupy or rasping. 

Hyoscine is an uncertain remedy in nervous affections, sometimes 
acting very well, at others producing very alarming symptoms in 
cerebration, circulation, and respiration. 

Hyoscine is official in the form of Hyoscine Hydrobr ornate (Hyos- 
cinae Hydrobromas, U. S.). 



HYPNAL. 

The chemical name of this substance is monochloral-antipyrine, 
and it is, as its name indicates, a compound of chloral and antipyrine. 
There is also a dichloral-antipyrine, which contains more chloral. The 
compound is employed in treating those patients who suffer from pain 
and insomnia combined, the antipyrine relieving the pain and the 
chloral producing sleep. Opium is the only drug known which can 
be relied upon to act in this double manner, and the disadvantages of 
that medicament are often so prominent as to prevent its use. In 
cough arising from bronchitis or phthisis, and causing by its con- 
stancy loss of sleep, and in neuralgic insomnia, hypnal will be found 
of service. The dose is from 5 to 20 grains (0.35-1.3), best given 
with simple syrup and water or with syrup of orange-peel, or it may 
be used as follows : 

R.— Hypnal gr. xv (1.0). 

Chartreuse f£j (4.0). 

Distilled water f§ss (16.0).— M. 

S. — The entire amount to be taken in one dose. 



ICHTHYOL. 

Ichthyol is a substance obtained by distillation from a peculiar 
resinous accumulation found chiefly in the Tyrol, and supposed to be 
the result of a deposit of extinct fish. Ichthyol occurs as the ich- 

1 The writer has given one-tenth of a grain of Merck's hyoscine in twenty-four 
hours, obtained from two different and reliable stores, without producing sleep, 
although the respirations were much quickened. 



IGHTHYOL. 211 

thyosulphate of sodium or ammonium. The latter is the salt com- 
monly employed, and is semi-solid. Both of these contain about 10 
per cent, of sulphur, and it is largely upon this that their therapeutic 
activity depends. The disagreeable odor of ichthyol depends upon 
the presence of an inseparable volatile oil. 

Therapeutics. — Ichthyol is without doubt one of the most remark- 
able substances used for medicinal purposes which has appeared in 
the last decade. In skin diseases it has been most highly recom- 
mended on both sides of the Atlantic, and is employed in the form 
of ichthyol ointment in chronic eczema, acne, urticaria, and even on 
lupus and keloids. In almost all chronic skin affections it is of the 
greatest value, and the writer has seen it exert a most favorable 
influence upon erysipelas both in hospitals and in his private practice. 
Under these circumstances the ointment should contain about 20 per 
cent, of ichthyol, or less. Some practitioners recommend that ich- 
th} T ol be applied in a watery solution of the strength of 1 drachm to the 
ounce (4.0 : 32.0) by means of a camel's-hair brush. Under these cir- 
cumstances it is necessary to wash the parts with oil and water every 
day, using the greatest gentleness. It has also been found by the writer 
very efficacious in the pain and swelling accompanying acute rheuma- 
tism of the joints, both during and after the acute stage of the dis- 
ease. The strength for this use should be about 30 parts of ichthyol 
to 70 of benzoinated lard. In frost-bites, chilblains, and in burns it 
is of service, and Agnew has recommended it highly when rubbed 
into lymphatic enlargements. Ichthyol has proved remarkably effica- 
cious in removing peri-uterine and other pelvic exudations when used 
as a salve or in a vaginal suppository. 

For acute sprains, and for the removal of the swelling following 
such injuries, its influence is extraordinary if it be well rubbed into 
the part affected. 

In severe cases of cracked nipples, with much induration, an oint- 
ment of ichthyol, 1 drachm to 4 (4.0-16.0) of lanolin will prove of 
value, but it must be wiped off before each nursing or the child will 
not take the breast. Often the odor remains and prevents nursing. 

Owing to the disagreeable odor of ichthyol, oil of citronella ought 
to be added to it, as follows : 

R.— Ichthyol . . 3ij (8.0). 

01. citronellse gtt. xv vel xxx (1.0-2.0). 

Adipis 3j (32.0).— M. 

The dose of ichthyol internally is 1 to 10 grains (0.05-0.65), given 
in pill. When used in this way the sodium salt should be used. 

Untoward Effects. — Bergerio and Peroni have both reported dis- 
agreeable symptoms from the intra-uterine application of ichthyol 
after curetting. As the drug ought not to be so used, such reports 
are of little practical value. 



IODIDE OP AMMONIUM. 

(See Ammonium Iodide.) 



212 DRUGS. 

IODIDE OF ETHYL. 

(See Ethyl Iodide.) 

IODIDE OP POTASSIUM. 

The physiological effects of iodide of potassium {Potassii Iodidum, 
U. S. and B. P.) are entirely comparable to those of iodine itself, but 
it is employed for somewhat different purposes, is less irritant, more 
readily given, and perhaps more readily absorbed. 

Physiological Action. — Circulation. — Upon this part of the sys- 
tem iodide of potassium produces effects differing very slightly, if 
at all, from those caused by potassium itself. Small amounts raise 
the blood-pressure, and large quantities lower it (Prevost and Binet). 

Elimination. — Iodide of potassium is very rapidly eliminated, 
appearing in the urine, according to Doux, in thirteen minutes after 
it is ingested, and the daily amount excreted equals about 80 per cent, 
of the dose taken. All traces of the iodide in the urine cease four 
or five days after the last dose is administered (Elhers). 

Therapeutics. — The use of iodide of potassium may be divided into 
three great divisions, each of which is important. It is also employed 
for many conditions not included in these classes : 

1. Syphilis. — The use of iodide of potassium in syphilis is recog- 
nized as a part of all treatment for its relief. Elsewhere Dr. Martin 
has, in his excellent article (see Syphilis), treated of this question, 
and it is only necessary to call attention to the fact that the drug 
is generally well borne in large amounts by advanced syphilitics, 
although this is not always the case. The term " therapeutic test " 
is applied by one eminent teacher to signify a state of the system 
produced by syphilis in which a diagnosis may be made by the fact 
that large doses of the iodide are borne without inconvenience. As 
already intimated, this resistance does not always prove the presence 
of syphilis, nor does its absence prove the absence of this disease. 
Persons having hereditary asthma, gout, rheumatism, or some similar 
diathetic malady often resist the iodide, and some syphilitics are 
affected with " iodism " after very small doses. In treating syphilis 
the drug should be used in the dose of 10 grains (0.65) three times a 
day, and this amount gradually increased a grain a day until symp- 
toms of "iodism" occur. 

The quantity borne often amounts to from 100 to 200 grains 
(6.0-13.0) a day. The best way to use the iodide of potassium is to 
order for the patient a saturated solution of the drug, which contains 
in each drop about 1 grain, and at the same time a bottle of the com- 
pound syrup of sarsaparilla. To a tablespoonful of the latter the 
patient is to add the iodide solution, beginning with 10 drops (0.65) 
three times a day and increasing a drop every twenty-four hours. 

The iodide acts more slowly as an antisyphilitic than does mercury. 

In tertiary syphilis the iodide is invaluable. 

In nervous syphilis, be its manifestations what they may, iodide of 



IODIDE OF POTASSIUM. 213 

potassium is the standard remedy, only being supplanted by mercury 
when it is necessary to break down a growth whose existence is a daily 
menace to the patient's life. 

2. Metallic Poisoning. — Owing to the fact that iodide of potas- 
sium forms double soluble salts with all the metals in the tissues in 
chronic poisoning, thereby aiding in their elimination, it should always 
be employed in chronic lead, zinc, arsenic, or mercurial poisoning. 

3, Antirheumatic— Iodide of potassium is best suited, not to 
the acute sthenic stages of rheumatism, when the joints are very hot 
and painful, but to the secondary or subacute periods, when the joints 
are large and the case "hangs on " — now better, now worse. It acts 
best, under these circumstances, if combined with wine of colchicum- 
root. (See Rheumatism.) It is also to be tried in sciatica, lumbago, 
and rheumatic neuralgia, and should be employed in chronic pleurisy, 
pericarditis, and hydrocephalus to cause absorption of the fluids. 

In aneurism, particularly that of the aorta, the drug does good, 
but its value rests largely upon the cause of the disease. If it is due 
to syphilis, the aneurism yields very rapidly to the drug. The pain, 
swelling, and pulsation generally decrease. 

In asthma iodide of potassium is valuable if the disease is of the 
pure bronchial type, but it ought not to be employed if it is gastric. 
In bronchitis and intestinal catarrh where the condition of the mucous 
membranes is semi-chronic, and not relieved by chloride of ammo- 
nium, iodide of potassium should be used. If the bronchitis is chronic 
and the secretion profuse (bronchorrhoea), iodide of potassium will 
make it worse. The dose for an adult in all these instances should 
be about 3 to 5 grains (0.15-0.3) three times a day. In pulmonary 
emphysema iodide of potassium is often of great value. 

In chronic nephritis small doses (5 grains (0.35) t. d.) are thought 
by some to check the disease, but it is to be remembered that the 
drug may produce poisoning if the kidneys do not eliminate it, so that, 
if used at all, it must be with great care. If the drug is well borne, 
it will cause an extraordinary increase in the urinary flow, and will 
relieve any dropsy which may be present very rapidly indeed. 

In bronchocele the employment of iodide of potassium internally 
and tincture of iodine externally is the best treatment we can use, 
and in acute coryza, or '• cold in the head," 10 grains (0.65) of the 
iodide taken at the beginning of the trouble will often abort the 
attack. 

In hepatic cirrhosis, in its early stages, the iodide often does 
good, and in arteriosclerosis or atheroma of the blood-vessels it is 
of great service, according to many English, French, and American 
writers. 

A very important use of iodide of potassium is for the removal of 
enlargements of the cervical glands and those occurring in other parts 
of the body. In enlargements of the spleen, malarial or otherwise, 
external paintings with iodine and the internal use of the iodide in 
small doses are of service. In the later stages of pneum.onia the 
iodides are useful to aid in the absorption of any exudates, but they 
are contraindicated in phthisis, except in the fibroid form and in 



214 DRUGS. 

many of those cases which are dependent upon syphilis as an under- 
lying dyscrasia, as they aid in the breaking down of the lung. 

Untoward Effects. — In some persons, after the use of the iodide, 
coryza with a tearful condition of the eyes comes on, so that the edges 
of the lids become reddened and the nose runs constantly. This is 
followed, if the drug is pushed, by the more positive signs of " iodism " 
spoken of under Iodine. 

In other cases acne breaks out on the face and disorders of diees- 
tion and gastric irritability come on. The acne can nearly always be 
prevented by giving arsenic at the same time with the iodide. In 
some cases petechial rashes break out on the leg, while in others great 
mental and physical depression appears, so that listlessness or melan- 
cholia may develop. 

In persons susceptible to iodide of potassium care should be exer- 
cised when it is first administered lest sudden and dangerous oedema 
of the glottis occur. Eisner has reported a case in which death fol- 
lowed the administration of 30 grains of the iodide of potassium. 
Multiple hemorrhages from the skin and mucous membrane occurred. 

Sometimes the iodide of ammonium or iodide of sodium will be 
borne when the iodide of potassium will not. 

If bullae or blebs follow the use of the iodides or other rashes 
appear, it is said that atropine will afford relief. 

Administration. — The iodide of potassium, owing to its exceed- 
ingly disagreeable taste, should be given with the compound syrup of 
sarsaparilla, extract of liquorice, or in milk. Large amounts of these 
vehicles are to be used. A good way to give it, when the physician 
fears it will disorder the stomach, is to add the drug to one of the 
liquid pepsins, and then to add this to warm milk, as in the directions 
for junket given in Part III. The curd completely covers the taste 
of the drug, as was first noted by Delavan of New York. The dose 
varies from 5 to 60 grains (0.35-4.0), according to the condition of the 
patient. 

One of the best ways to take the drug is in capsule, but if this is 
done a drink of milk or water or other fluid should precede or follow 
it, in order to prevent the drug from coming in contact with the 
stomach in concentrated form. The preparations of the iodide of 
potassium are — Unguentum Potassii Iodidi, U. S. and B. P., and the 
liniment (Linimentum Potassii Iodidi cum Sapone, B. P.). The 
former should always be freshly prepared. 



IODIDE OP SODIUM. 

Sodii Iodidum, IT. S. and B. P., is used in the same doses and for 
the same purposes as the iodide of potassium. 



IODINE. 

Iodum, U. S. and B. P.. is a non-metallic element found largely 
in seaweed and in mineral iodates and iodides. It is soluble in ether 



IODINE. 215 

and alcohol, but slightly so in water, and possesses an acrid, burning 
taste and a neutral reaction. 

Physiological Action. — The physiological action of iodine, so far as 
its alterative powers are concerned, is absolutely unknown. Applied 
to the skin, it stains it yellow, brown, or black according to the free- 
dom of its application, and it acts without pain if the skin is intact. 
If very large amounts are used, it produces vesication. Upon mucous 
membranes iodine acts as a powerful irritant. Germain-See believes 
it to be a stimulant to the nutritive processes of the body and to the 
circulatory system, and he is certainly correct in regard to the influ- 
ence it exercises over nutrition. 

Elimination. — The drug escapes chiefly through the kidneys, the 
skin, the salivary glands, and it even appears in the milk of nursing 
women. 

Poisoning. — The symptoms of acute poisoning by iodine are those 
of acute gastro-enteritis, with severe pain in the oesophagus, stomach, 
and abdomen, accompanied by violent vomiting and purging. An 
early symptom is the persistent strong metallic taste in the mouth, 
with markedly increased salivation. The pulse becomes rapid, 
running, and feeble, the face deathly pale, total arrest of urinary 
secretion takes place through renal irritation, and death occurs 
by failure of respiration, which is accompanied by loss of all vital 
power. 

If the poisoning is not severe enough to cause death at once, a 
fatal result is, nevertheless, often reached after a few days by reason 
of a widespread fatty degeneration of the tissues. 

The treatment of the poisoning consists in the use of large amounts 
of starch in any of its forms as the antidote, the employment of 
emetics and the stomach-pump, the application of heat to the body 
and extremities, and, finally, the employment of hypodermic injections 
of alcohol, digitalis, ammonia, and atropine or strychnine, for the 
purpose of maintaining the strength of the circulatory and respira- 
tory system. 

Chronic Poisoning.— Under the name of " iodism " the profession 
recognizes a state of the body brought on by the prolonged and 
excessive use of iodine in any of its forms. The earliest signs of 
this state are shown by a peculiar metallic taste in the mouth, par- 
ticularly before breakfast, slight tenderness of the teeth and gums, 
increase of salivary secretion, a little morning nausea and a lack of 
appetite for breakfast, and perhaps some coryza or evidence of gastric 
irritation. Acne rosacea often comes on very early. If the drug is 
continued, all these symptoms become more marked and the coryza 
becomes intense. Headache under the frontal bone and sore throat 
often appear, and the pustular and bleb-like changes in the skin go 
on to active suppuration. Sometimes large boils appear or purpura 
hemorrhagica comes on. 

In other cases the nervous system chiefly suffers. Twitchings of 
muscles, neuralgic pains in the trunk and extremities, and wasting 
of the testicles, mammae, and all other tissues occur as the result of 
trophic disturbances. Anaemia amounting to an actual cachexia is 



216 DRUGS. 

commonly produced. Loss of vision and paralysis may ensue in 
extreme cases. 

Therapeutics. — In all cases where the system is in a state of 
chronic perverted functional activity, as in those diseases associated 
with disorder of the processes of nutrition, and often included under 
the single name of scrofulosis, iodine is of service. In enlargement 
of the lymph-glands it is, in its various forms, one of the best rem- 
edies we possess, but it ought not to be employed in those cases where 
rapid changes are going on in the gland, such as the formation of 
pus, since under these circumstances it will increase the size of the 
slough. The drug ought never to be used in rapid phthisis, because 
it tends to disintegrate the tissues, and this is precisely what the dis- 
ease is doing. In the exceedingly chronic form of pulmonary disease 
known as fibroid phthisis iodine may be used. When inhaled in fumes 
it may be of service as a stimulant to the mucous membranes, but is 
never of value in phthisis otherwise. In countries where exophthal- 
mic goitre is very prevalent iodine ranks as a most efficient remedy. 
In cystic enlargement of the thyroid gland it is valueless, but in sim- 
ple hypertrophy of the gland is of great value. 

In chronic bone disease iodine applied about the affected joint in 
the form of the ointment diluted one-half with lard, or in the pure 
tincture, will be found of service, and if anannia exists the syrup of 
the iodide of iron should be given internally. 

The other uses of iodine externally are many and important. As 
a slow counter-irritant, which does not produce pain if properly 
employed, it is particularly useful in children, and may be employed 
in one to three coats, and no more. 

The proper way of using the tincture is to give one good black 
coat at one sitting, and not to repeat it until the skin has desqua- 
mated and become well renewed. If iodine is applied soon after one 
good effective coat, it will cause agonizing burning pain, which noth- 
ing will relieve except the removal of the iodine by the use of cologne- 
water, alcohol, whiskey, or gin. The application of any of the latter 
liquids causes such an increase in the pain as to be almost useless 
after the skin is broken. The best solution for its removal is one of 
iodide of potassium, which should be followed by a starch poultice. 
A good rule to follow is never to cause pain by the use of iodine, as 
the drug acts equally well if applied in such a way as to avoid 
suffering. 

Iodine in the form of the tincture is applied as a counter-irritant 
paint in pleurisy, both to abort an attack and to aid in absorption of 
the fluid after it is thrown out into the chest. In harassing irritative 
eough it may be painted over the supraclavicular spaces, and it will 
lessen the secretion in chronic bronchitis if used in this way. In 
chronic rheumatism affecting the joints and muscles it does good when 
locally applied.. Often in synovitis the local application of iodine 
causes increased swelling for some days. . This should not cause 
alarm, for ultimately the swelling decreases very greatly, and the 
cases in which this occurs are generally the best from a prognostic 
point of view. 



IODINE. 217 

In the course of phthisis every now and then a "spot" in the 
chest will become " sore," probably due to a limited area of pleurisy, 
and under these circumstances tincture of iodine locally applied will 
give relief. In lupus the tincture may be painted around the edges 
of the growth, and even over its surface, with the object of retarding 
its spread. In chilblains an application of iodine ointment gives the 
greatest relief if diluted one-half with lard, and its use is probably 
the most efficacious measure at our disposal. In certain individuals 
who have "pains in the chest" iodine ointment may do good if 
applied over the spot. As has been pointed out by others, iodine 
does good if muscular tenderness is present, while it fails if pleuro- 
dynia or intercostal neuralgia is the cause of the suffering. The lat- 
ter troubles should be removed by the use of belladonna. In certain 
forms of skin diseases, such as tinea tonsurans and circinata, tincture 
of iodine may be applied with a camel's-hair brush, and even the 
entire scalp may be painted. A better way is to apply it to different 
spots each day. When erysipelas is present, the tincture may be 
painted around the edges of the inflammation in order to prevent its 
spread. 

In old persons or those in middle life retraction of the gums from 
the teeth sometimes comes on, and Stille' recommends for this dis- 
order the use, by means of a camel's-hair brush, of a watery solution 
of iodine of the strength of 1 grain to the ounce (0.05 : 32.0), to be 
followed at once by a thorough rinsing of the mouth with pure water. 
In hydrocele iodine in the form of the tincture is the best remedy for 
effecting a permanent cure that we have. The sac should first be 
emptied by the use of a trocar and canula, and the iodine alone or 
with glycerin injected with a syringe, and then allowed to escape. 
As the pain is most atrocious, the patient should first be put partly 
or entirely under the influence of ether or other anaesthetic. 

In white swellings and ovarian tumors as much as 10 ounces 
(320.0) of the tincture may be injected, but it is to be remembered 
that certain dangerous symptoms may arise. After its use in this 
way in the chest violent symptoms of poisoning have come on in 
some cases, the most common complication being convulsions. 
These are epileptiform in character and are followed by coma or 
collapse. 

In empyema a solution of iodine 6 grains (0.37), iodide of potas- 
sium 6 grains (0,37), and water 1 pint (500 cc), may be used daily 
as an irrigating fluid with good results. 

The tincture of iodine may be used, according to Ringer, as an 
inhalation with signal benefit in the following four instances : 

1. In the chronic forms of phthisis [fibroid lung), When the 
expectoration is abundant and when the cough is troublesome, its 
inhalation, used both night and morning, will generally lessen the 
expectoration and allay the cough. 

2. In children six to ten years of age, who after meals, or, inde- 
pendently of them, on exposure to cold, are seized with hoarseness, a 
hoarse, hollow cough and some wheezing at the chest. This affection, 
involving the larynx, trachea, and larger bronchial tubes, and often 



218 DRUGS. 

proving very obstinate, is apt to return and to persist a considerable 
time. 

3. In some epidemics of diphtheria the inhalation recommended by 
Dr. Waring-Curran is of value, and consists of 4 grains (0.2) of iodine 
and 4 ounces (128.0) of water. A teaspoonful of this should be added 
to boiling water and kept hot by a spirit lamp, whilst the steam is- 
inhaled. As the patient becomes accustomed to the iodine, the quan- 
tity of the solution may be increased till \ an ounce of it is used at 
each inhalation. It should be repeated many times a day, and each 
inhalation continued from eight to twelve minutes. 

4. Some persons suffer with itching of the nose, of the inner canthus 
of one or both eyes, sneezing, running at the nose of a watery fluid, 
weeping of the eyes, and severe frontal headaches ; and these patients, 
of various ages are greatly troubled, often for many years, with daily 
attacks of this character, lasting, it may be, several hours. Iodine 
inhaled often removes this affection at once, lessening the headache 
and discharge from the nostrils. Its effect is most marked in respect 
to the itching. 

Ringer generally adopts the following simple, handy, cleanly, and 
effectual plan of inhalation : Heat well a jug capable of holding about 
2 pints, by rinsing with boiling water, then partly fill with boiling 
water, into which pour 20 to 30 drops (1.3-2.0) of the tincture of 
iodine, then direct the patient to put his face over the mouth of the 
jug and breathe the iodized steam, covering the head to prevent the 
escape of the vapor. This inhalation should be used night and morn- 
ing for five minutes or a little longer. Occasionally an excess of 
iodine will temporarily produce a sensation of soreness in the chest 
and throat, accompanied with redness of the conjunctiva, running 
from the nose, and pain in the head. 

In some cases of acute coryza much relief may be obtained by sniff- 
ing the iodine from a bottle, as in the use of ''smelling salts." The 
heat of the hand is sufficient to disengage the vapor in proper quantity. 

Administration. — Iodine is never used in solid form, and it has 
been taught that the tincture (Tincture Iodi, U. S. and B. P.) should 
not be given internally, on the ground that it is precipitated in the 
stomach. Whether this be true or false, it is a fact that the tincture 
has recently been largely used in the vomiting of pregnancy with very 
good results. The dose is 5 to 10 drops (0.35-0.65), well diluted. 
Under the name of Lugol's solution (Liquor Iodi Compositus, U. S.) 
iodine is frequently used internally ; the dose is 5 to 10 drops (0.35- 
0.65), in water. The B. P. preparations not official in the U. S. P. 
are the liniment (Linimentum Iodi), the solution (Liquor Iodi), and 
Vapor Iodi, which is prepared by adding 1 fluidrachm (4.0) of iodine 
to 1 fluidounce (32.0) of water, which is gently heated and the rising 
vapor inhaled. 

Within recent years a so-called colorless tincture of iodine has 
been sold which has obvious advantages, and is made by the following 
process, according to Curtmann and Aiken of St. Louis : Take of 
iodine 1J ounces (48.0), alcohol 13 fluidounces (416.0), of stronger 
water of ammonia 3 fluidounces (96.0). Dissolve the iodine in the 



IODOFORM. 219 

alcohol and add the ammonia. Allow to stand for four weeks with 
repeated shaking. Or the preparation may be made hastily by using 
an excess of ammonia, and afterward cautiously adding enough hydro- 
chloric acid to render the liquid only feeble alkaline. Iodide of 
nitrogen may be precipitated, which is explosive. 

Unguentum Iodi, U. S. and B. P., is used locally over enlarged 
glands. In the case of children or adults who have delicate skins the 
ointment should be diluted one-half with lard. This ointment should 
always be freshly made. 

Contraindications. — Iodine is contraindicated in renal diseases, 
except in small doses, during the progress of acute inflammation, 
and whenever tissues are rapidly undergoing degenerative changes. 



IODOFORM. 

Iodoform (Iodoformum, U. S. and B. JR.) occurs in small saffron- 
colored crystals which possess a powerful characteristic, penetrating 
odor and strong taste. It is soluble in alcohol, ether, chloroform, 
benzol, and in fixed and volatile oils, but is insoluble in water. 

Physiological Action. — The effects of iodoform upon the circulation, 
respiration, and other vital functions are very slight when the drug is 
used as a surgical dressing in ordinary amounts or when it is given by 
the mouth in average doses. It acts as an anaesthetic upon mucous 
membranes, and produces those changes which we are wont, for want 
of a better term, to call "alterative," in the tissues with which it 
comes in contact. Iodoform is eliminated as iodine or as alkaline 
iodides, chiefly iodide of sodium. The drug also escapes by the saliva. 

Poisoning. — If applied to an absorbing surface in susceptible indi- 
viduals, iodoform may cause general systemic poisoning. This poison- 
ing may be mild, in which case we have a general feeling of malaise, 
with nausea and the perception of various odors which are in reality 
not present. There may be headache and vomiting. If the system 
is still more impressed by the drug, these symptoms are followed 
by cerebral excitement, insomnia, loss of memory, loss of appetite, 
and a rapid pulse. In very grave cases these symptoms are fol- 
lowed by convulsive movements, maniacal delirium, alternating with 
coma. The pulse is small and rapid, and there is often retention of 
urine or hematuria. Loebisch asserts that the mental excitement 
cannot be quieted by narcotics. If death occurs, the heart and 
respiration fail side by side. In addition to the fatty degeneration 
which such poisoning produces in all the vital organs, there is some- 
times found an oedematous condition of the pia mater or a low-grade 
leptomeningitis. These symptoms seem to occur more commonly in 
the aged, and in the graver cases the onset is apt to be sudden, though 
it is generally from twenty-four hours to several days between the 
application of the drug and the onset of poisoning. 

Treatment of the poisoning by iodoform consists, according to 
Soullier, in the administration of bicarbonate of sodium to unite with 



220 DRUGS. 

the iodine and so aid in its elimination ; the use of alcoholic stimu- 
lants to support the system ; the employment of diuretics and wrap- 
ping the patient in hot blankets to encourage free sweating, so reliev- 
ing the kidneys. Kocher advises saline transfusion. 

Therapeutics. — Iodoform is used chiefly as a surgical dressing. It 
is antiseptic, but not germicidal. Germs may be found in powdered 
iodoform, and will even grow in it. The drug does good by absorb- 
ing the liquids of the wound, and thereby removing the nidus for 
germ-growth, and when applied to large moist surfaces gives oif free 
iodine and acts as well as a protective. There can be no doubt that 
iodoform when applied to a wound does good, not by destroying the 
bacteria directly or indirectly, but by inducing chemical changes in 
their toxines. 

In syphilitic sores the following dressing will be found of great 
service: Iodoform, 20 grains (1.3); oil of eucalyptus, J fluidounce 
(16.0); or a powder of iodoform J an ounce (16.0), camphor 75 
grains (5.0), and essence of roses 2 drops (0.1), may be employed. 
In eczema, with tingling and itching, the following application will 
give relief (Ringer) : 

R. — Iodoformi gr. iv (0.2). 

Olei eucalypti fcj (4.0). 

Petrolati ^j (32.0).— M. 

S. — Apply locally. 

Internally, iodoform is used in tertiary syphilis in all its forms in 
the dose of from 1 to 5 grains (0.05-0.35). Bartholow recommends 
it most highly in catarrhal jaundice and in the early stages of hepatic 
cirrhosis ; indeed, he thinks its persistent use in small dose will cure 
this affection. 

The influence of iodoform upon the tubercle bacillus is very great, 
and it is now largely used in the treatment of tubercular disease of 
the joints and pleurae. The pus is allowed to escape under antiseptic 
precautions; the cavity is washed out with warm boric-acid or carbolic- 
acid solutions of low strength, and from 1 to 6 drachms (4.0-24.0) of 
an emulsion of iodoform and sterilized sweet oil are injected and 
allowed to remain. The strength of the iodoform-and-oil emulsion 
is 10 per cent. Should the abscess-cavity fail to heal after these 
injections have been repeated every few days for some time, it must 
be reopened, scraped, and injected again or packed with iodoform 
gauze. The iodoform also promotes healing through its alterative 
influence, which aids in the absorption of the inflammatory exudate. 
Should tubercular glands be present, injections may be made into 
them even if pus has not formed. 

Used by means of a powder-blower, iodoform will often relieve the 
hoarseness and discomfort of laryngeal phthisis, but it must be pulver- 
ized most minutely. Sometimes a spray may be used, which should 
consist of spirits of turpentine and sweet oil, half-and-half, and contain 
2 grains (0.10) of iodoform to each ounce (32.0). This mixture may 
also be used in bronchial catarrh to lessen the cough and foetid dis- 
charge. In the early stages of phthisis several clinicians claim to 
•have reached very good results by the daily hypodermic injection into 



IPECACUANHA. 221 

the back of 30 minims (2.0) of a 1 : 100 solution of iodoform in oil 
of sweet almonds. 

In fissure of the anus and irritated hemorrhoids 5 grains (0.35) 
of iodoform in a suppository may be placed in the rectum, and after 
it has remained there a few minutes defecation may be had without 
pain. The pain following operations ori the female perineum may 
also be much relieved in this manner. In the tenesmus of cholera 
infantum an injection of 1 ounce (32.0) of sweet oil with 5 grains 
(0.35) of iodoform will give great relief if used after or before 
enteroclysis. 

Administration. — The ointment ( Unguentum Iodoformi, U. S. and 
B. P.) is useful when applied over foetid sores. It should always be 
freshly made. The drug itself may be given in 1- to 5-grain (0.05- 
0.35) doses three times a day- The suppositories (Suppositoria Iodo- 
formi) are official in the B. P. ; each one contains 3 grains (0.15) 
of iodoform. 

IODOL. 

This is a dark, dirty-yellowish-looking powder, soluble in alcohol, 
ether, and oils, but only slightly so in water. Its uses in medicine 
are identical with those of iodoform, and it possesses the advantage 
of being not so penetrating in odor as the latter drug. 

In tubercular laryngitis the powder may be blown into the larynx 
without disagreeable results and with a favorable effect on the dis- 
eased process. Cerna has found iodol of very great service in dia- 
betes when given internally, in the dose of from 2 to 6 grains (0.1- 
0.3) three times a day, and it is said to be of value in tertiary syph- 
ilis in the same quantity. 

A very useful antiseptic dressing for small wounds and abrasions 
is made by adding 1 part of iodol to 10 parts of ether and 5 of gun- 
cotton, thereby preparing an iodol collodion. 

Ingalls recommends the following prescription in cases of eczema 
or abrasions of the upper lip and nostrils : 

R .—Acid, carbolic T^vj (0.3). 

01. ros?e TT\,v (0.3). 

Iodol gr. xxv (1.65). 

Lanolin §ss (16.0).— M. 

IPECACUANHA. 

Ipecacuanha, TJ. S. and B. P., or Ipecac, is the root of Cephaelis 
Ipecacuanha, a small shrub of Brazil. It contains an alkaloid, eme- 
tine, and ipecacuanhic acid. 

Physiological Action. — Locally applied to mucous membranes, ipe- 
cac acts as an irritant, and if applied for a long period to the skin 
produces vesicles and irritation. Very minute doses have little notice- 
able effect, but large ones produce nausea, relaxation, vomiting, free 
secretion into the bronchial tubes, and a profuse flow of saliva. The 
emesis is due both to the irritation of the stomach and to an effect 
upon the vomiting centre in the medulla. 



222 DRUGS. 

If emetine is given in lethal dose, death is due to failure of res- 
piration. 

Therapeutics. — Ipecac is used as an emetic where a fairly rapid 
action is required. It is particularly useful in cases where the stom- 
ach of a child is overloaded with food. In cases of poisoning it is 
hardly active or rapid enough as an emetic, and is not as good as 
mustard or sulphate of zinc. In babies and young children an attack 
of bronchitis often causes digestive disorders, by reason of the mucus 
coughed up from the lungs being at once swallowed instead of spit 
out of the mouth. In these cases the stomach may be relieved and 
the state of the lungs improved by the use of an emetic dose of 
syrup of ipecac, 2 to 3 drachms (8.0-12.0). Often if the dose be 
not large enough to produce emesis it will purge the child and remove 
the mucus by the bowel. 

In obstinate vomiting small doses of ipecac will act as a most suc- 
cessful cure, provided that the vomiting is due not to inflammation 
and excitement, but to depression. The irritant effect of the ipecac 
stimulates the depressed organ up to a normal tone. The proper dose 
of ipecac for this purpose is \ to \ a grain (0.016-0.03) or less every 
half-hour until five or six doses are taken. 

Ipecac is also said to possess marked oxytocic properties, similar 
to quinine, when given in small doses, 10 to 15 drops (0.65-1.0), of 
the wine every two or three hours. 

In some cases of the vomiting of pregnancy it is very useful, in 
others it utterly fails. 1 drop of the wine or 1 or 2 grains of the 
powdered ipecac is all that should be used. In vomiting with flatu- 
lence either ipecac or nux vomica is of service. In the morning vomit- 
ing of drunkards ipecac is of service, but it is not so good a. remedy 
as small amounts of arsenic or hydrochloric acid. 

In true acute dysentery ipecac is the best remedy we possess. 
When the passages are large and bloody and the disease is malignant, 
as it occurs in the tropics, ipecac should be given in the following 
manner : The powdered ipecac is to be administered in the dose of 
60 grains (4-0) at once to produce vomiting. After vomiting has 
taken place small doses of 3 grains (0.2) are to be given every hour, 
and continued until a profuse black stool is passed. The passage of 
this stool is a most favorable prognostic sign, and its non-appearance 
is equally significant of danger. Vomiting is to be controlled with 
opium, and stimulants are to be freely used to avoid great depression. 

In choleraic diarrhoeas and cholera morbus ipecac is often of great 
service in the dose of 3 grains (0.2) every two hours. No less a per- 
son than the great Trousseau asserted that ipecac was a hcemostatic, 
and it is said to be a most effective remedy in haemoptysis in small 
doses. 

As an expectorant ipecac is to be used in the early stages of bron- 
chitis^ to act as a sedative to the inflamed mucous membrane and to 
promote secretion. Under these circumstances it is best combined 
with citrate of potassium. (See Bronchitis). 

Ringer and Murrell have found that inhaling ipecac spray is very 
useful in chronic ivinter cough or bronchitis, particularly when there 



IBOK 223 

is present shortness of breath. The pure wine may be used in a 
spray apparatus or be diluted one-half with water. While the throat 
may seem temporarily worse, the shortness of breath rapidly decreases 
and a great improvement takes place in the cough. In order to pre- 
vent the wine which collects in the mouth from being swallowed, the 
patient should be directed to rinse his mouth thoroughly every few 
minutes, lest nausea and vomiting be produced. The inhalation 
should not last at first over three or four minutes, and, until it is 
known how well the patient will bear the application, the wine should 
be diluted twice or thrice. 

Administration. — The syrup (Syrupus Ipecacuanha?, U. S.) is given 
in the dose, of J to 1 drachm (2.0-4.0) as an expectorant, or in the 
same dose as an emetic to an infant. The wine ( Vinum Ipecacuanha?, 
B. P.) is given in the same dose as the syrup, the fluid extract 
(JExtractum Ipecacuanha* Fluidum, U. S.) in the dose of 30 drops 
(2.0) as an emetic to an adult, and the troches (Trochisci Ipecacuanha?, 
U. S. and B. P.) \ of a grain (0.016) each. Trochisci Morphinoe et 
Ipecacuanha?, U. S. and B. P., containing -^ of a grain (0.002) of 
morphine and y 1 ^- of a grain (0.006) of ipecac, are used in sore throat, 
dissolved in the mouth. Dover's powder {Pulvis Ipecacuanha? et 
Opii, U. S. ; Pulvis Ipecacuanha? Compositus, B. P.) is given in the 
dose of 5 to 15 grains (0.35-1.0). It contains 1 grain (0.05) of 
opium, 1 grain (0.05) of ipecac, and 8 grains (0.5) of sugar of milk. 
(See Opium.) 

Emetine may be given in the dose of -^ to ^ grain (0.006-0.012) 
as an emetic. 

The pill of ipecac and squill (Pilula Ipecacuanha? cum Scilla, 
B. P.) is given in the dose of 5 to 10 grains (0.35-0.65). Vinegar 
of ipecac (Acetum Ipecacuanha?, B. P.) is given in the dose of 5 to 
30 drops (0.3-2.6) as an expectorant. 



IRON. 

Iron (Ferrum, TJ. S. and B. P.) is a metal and a food — a food 
because it forms part of the body when taken into the organism and 
is used by the system in the making of blood. The number of its 
official salts and compounds is absurd, and half the list is rarely, if 
ever, used. 

Physiological Action. — Iron has little or no effect upon the system 
when given in a single dose, but repeated doses cause an increase in 
the number of red blood-corpuscles, and plethora, or an increase in 
the quantity and quality of the blood. Much discussion has arisen 
as to whether iron when given as a drug in form of one of the inor- 
ganic salts is absorbed. One theory has been that only the organic 
iron of the food is absorbed, and that metallic iron when given freely 
allowed this absorption to go on by stimulating the bowel to its ab- 
sorption, or by entering into combination with sulphuretted hydro- 
gen thus permitted the organic iron to escape into the system. That 
both forms of iron are absorbed and eliminated is now certain. (For 



224 DRUGS. 

a discussion of some of these views see article on Anaemia.) If given 
in excessive doses, much of it remains unabsorbed, is changed into the 
sulphide of iron in the bowels, and escapes with the faeces. Careful 
studies have shown that the iron, when once absorbed, escapes from 
the body very slow T ly, and that its pathway of escape is not by the 
bile or in the urine, but by the walls of the intestine, which excrete 
it, so that it may be recovered from the faeces. It has been asserted 
that it is never released from the body, but this is untrue. Whether 
it acts as a stimulant to blood-manufacture or simply supplies the 
glands with blood-making material we do not know, but the latter 
is probably the correct view. Iron causes oxidation to go on more 
rapidly by reason of its peculiar power of converting oxygen into 
ozone, and in this manner acts as a stimulant to nutrition and 
bodily activity. The studies of Skvortzoff are interesting in connec- 
tion with this subject. He found — 1. That iron has no marked influ- 
ence or nitrogenous metamorphosis in the healthy body. 2. The 
ingestion of iron in daily doses of 0.02 to 0.03 gramme (0.3 to 0.5 
grain) causes a very slight decrease in the assimilation of the nitrog- 
enous portions of the food. 3. After bleeding, the assimilation of 
nitrogenous substances increases a little, whether iron is used or not ; 
but if iron is used at this time the haemoglobin is rapidly reproduced, 
and the drug would seem to be of value in restoring the bodily 
weight. 

The preparations of iron consist in the soluble and insoluble salts 
or forms. Of these the insoluble are better than the soluble, because 
nearly all the soluble salts of iron are precipitated by the gastric juice 
and have to be slowly redissolved. 

Therapeutics. — The chief indication for iron is anaemia (see Anae- 
mia), and its chief contraindication is plethora. When used in small 
dose (J to 1 grain), it is quite as efficacious as in large amounts, 
and less apt to disorder the stomach. In some cases of anaemia of a 
semi-pernicious type large doses of iron are really needed, probably 
because the system is deranged in such a manner that an excessive 
loss or destruction of iron is constantly present. Large doses com- 
pensate for this leakage and afford the quantity needed for physio- 
logical purposes. It should not be used as a tonic unless some direct 
indication for its employment is present, and no drug is more abused 
in this respect than iron. As each of its preparations possesses some 
peculiarity, the use of each will be considered separately. 

Ammonio-ferric Alum. 

Ammonio-ferric Alum (Ferri et Ammonii Sulphas, U. S.) is often 
given in cases of atonic leucorrlicea in the dose of 2 to 5 grains (0.1— 
0.35). It is quite astringent. 

Aromatic Mixture of Iron. 

The Aromatic Mixture of Iron (Mistura Ferri Aromatica, B. P.) 
contains so little iron that it should not be administered in cases where 



IRON. 225 

a chalybeate influence is desired ; it is, however, a useful tonic, given 
in the dose of 1 to 2 fluidounces (32.0-64.0). Aromatic mixture of 
iron contains cinchona-bark, calumba, cloves, iron, compound tincture 
of cardamoms, tincture of orange-peel, and peppermint-water. 

Arsenate of Iron. 

Arsenate of Iron (Ferri Arsenas, B. P.) is used in the dose of 
IT t° A g ra -i n i n anaemic subjects who are suffering from skin diseases. 

Basham's Mixture. 

Under the name of Basham's Mixture {Liquor Ferri et Ammonii 
Acetatis, TJ. S.) a very useful and elegant preparation of iron is 
employed, particularly in the anosmia of Bright 1 s disease. It is 
made up as follows : 

Tincture of chloride of iron 2 parts. 

Dilute acetic acid , . 3 " 

Spirit of Mindererus 20 " 

Elixir of orange 10 " 

Svrup 15 " 

Water 50 " 

The dose is from 1 to 8 drachms (4.0-32.0), well diluted, and it acts 
as a diuretic, diaphoretic, and chalybeate. 

Bromide of Iron. 

Bromide of Iron (Ferri Bromidum) is said by DaCosta to be use- 
ful in qncemia, when this state is associated with chorea, in the dose 
of 5 to 20 grains (0.35-1.3) given in syrup. In other nervous dis- 
eases accompanied by anaemia and insomnia the syrup of the bromide 
of iron (Syrupus Ferri Bromidi) is useful in the dose of J to 1 
fluidrachm (2.0-4.0). 

Carbonate of Iron. 

The Carbonate of Iron (Ferri Carbonas Saccharatus, TJ. S. and 
B. P.) is very slightly astringent, and may be used in pill form under 
the name of Pilulce Ferri Carbonatis, TJ. S. and B. P., sometimes 
called "Blaud's pill," or in Griffith's pill, which also contains myrrh. 
The dose is 3 grains (0.15), and this preparation of iron may be 
largely used for the treatment of amenorrhoea dependent upon anaemia. 
Under the name of Mistura Ferri Composita, TJ. S., or Griffith's mix- 
ture, and B. P., we have a liquid preparation used for the same pur- 
poses as the pills, in the dose of 1 to 2 tablespoonfuls (16.0-32.0). 
Massa Ferri Carbonatis, TJ. S., sometimes called Vallet's mass, is 
given in pills in the dose of from 1 to 10 grains (0.05-0.65). 

Chloride of Iron. 

Tincture of the Chloride of Iron (Tinctura Ferri Chloridi, TJ. S.), 
often called Tincture of the Muriate of Iron, is one of the best and 
most useful preparations of iron that we have. It is the most diuretic 

15 



226 DRUGS. 

preparation of iron. This diuretic effect does not depend upon the 
presence of a muriatic ether, as has heretofore been taught, since 
hydrochloric ether is not present, and is hard to prepare except there 
is an excess of chlorine present. According to some researches of 
Dr. S. Weir Mitchell, the only ether present is nitrous ether, and 
this is devoid of power and in small quantity. As chloride of iron 
itself is diuretic, it is probably upon this that the diuresis produced 
by it depends. The dose of the chloride of iron (Ferri Chloridum, 
U. S.) is 1 to 3 grains (0.06-0.18). Tincture of the chloride of iron 
is considered a specific in erysipelas, and should be given in very full 
dose and frequently repeated if it is to be of any service. 10 drops 
(0.65), well diluted, every hour is not too much. In chronic Bright 's 
disease it is of value and decreases the albuminuria. In ancemia it is 
useful, and owing to its acid is a doubly effective tonic. In cases of 
slight anaemia in which very great arterial, pressure exists Dr. Mitchell 
uses a purely milk diet, and an ounce of an old tincture of iron in 
the twenty-four hours. While he recognizes the fact that iron prepa- 
rations are generally supposed to raise blood-pressure, he asserts that 
in this instance the blood-pressure is lowered. The dose of Liquor 
Ferri Chloridi, U. S., is 4 to 10 drops (0.2-0.65). It is rarely used 
internally, but chiefly as an astringent of great power. Liquor Ferri 
Chloridi, is identical with Liquor Ferri Per chloridi, B. P. Tinctura 
Ferri Perchloridi, B. P., is used internally in the dose of 10 to 20 
minims (0.65-1.3). 

As a local application tincture of the chloride of iron is useful in 
diphtheria and membranous croup, and even in tonsillitis. In each 
of these maladies large doses of the tincture internally, with counter- 
irritation over the neck, are most useful. When used internally it 
should be well diluted and taken through a glass tube to protect the 
teeth. The strong solution of perchloride of iron {Liquor Ferri Per- 
chloridi Fortior, B. P.) is a powerful styptic. 

Citrates and Tartrates of Iron. 

The four citrates of iron are soluble in water and very useful for 
this reason. Ferri Citras, U. S., and Ferri et Ammonii Citras, U. S. 
and B. P., occur in garnet-red scales and are given in the dose of 5 
grains (0.35). The solution of the citrate of iron (Liquor Ferri 
Citratis, U. S.) is given in the dose of 10 minims (0.65). The Ferri 
et Quinince Citras, B. P., and the Ferri et Strychnince Citras, U. S. 
and B. P., are given in the dose of 5 to 15 grains (0.35-1.0) and 1 
to 3 grains (0.05-0.15), respectively. The new official Ferri et 
Quinince Citras Solubilis, U. S., is given in the dose of 1 to 2 
drachms. 

Besides these citrates there are three tartrates — Ferri et Ammonii 
Tartras, U. S., and Ferri et Potassii Tartras, U. S., and Ferrum Tar- 
tar atum, B. P., all given in the dose of 5 grains (0.35). 

Dialyzed Iron. 
Dialyzed Iron (Ferrum Dialysatum) is a very feeble preparation 



IRON. 227 

of iron, lacking in astringency, easily precipitated from the solution 
in which it occurs, but largely used in ancemia by some practitioners. 
The dose is 10 to 20 drops (0.35-1.3) in water three times a day. 
Sometimes river-water, if it contains much inorganic or organic 
matter, will precipitate it. Owing to the instability of dialyzed 
iron, it may be used without any preparation as an antidote to 
arsenic. Liquor Fern Dialysatus, B. P., is given in the dose of 
10 to 30 minims (0.65-2.0). 

Hydrated Sesquioxide of Iron. 

Hydrated Sesquioxide of Iron (Ferri Oxidum Hydratum, TJ. S.) is 
the antidote to arsenic, but to be efficacious it must be freshly prepared. 
It is to be made by precipitating any liquid preparation of iron by 
the addition of an alkali, such as ammonia, or by the addition of mag- 
nesia. If ammonia is used, the precipitate has to be washed with 
water several times to get rid of the alkali, which will render the 
antidote too irritant to be swallowed if it is allowed to remain with 
the precipitate. Magnesia is an antidote in itself, and should be 
preferred under all circumstances. The antidote should be given in 
excess, and as much as a pint of the iron solution should be precipi- 
tated. The magnesia should be freely added, as too much of it can- 
not be given. The official antidote to arsenic is Ferri Oxidum Hydra- 
turn cum Magnesia, TJ. S. In the Prussian Pharmacopoeia this is 
known as the Antidotum Arsenici. (See Arsenic, Poisoning by.) 

Iodide of Iron. 

The Syrup of the Iodide of Iron (Syrupus Ferri Iodidi, TJ. S. and 
B. P.) is a transparent liquid of a sweet, iron-like taste. It should 
contain no free iodine, and if it strikes a blue color with starch should 
be discarded. It is largely used in anaemia associated with scrofulosis 
and struma, and is useful in the eczema of young children when this 
is dependent upon lack of vitality or anaemia. The dose to a child 
of two years is 2 to 3 drops (0.1-0.15), well diluted, and to an adult 
30 to 40 drops (2.0-2.65) in water, to be taken through a glass tube 
to protect the teeth. 

The saccharated iodide of iron (Ferri Iodidum Saeeharatum, TJ. S.) 
is used in place of the syrup in the dose of 2 to 5 grains (0.1-0.3). 
The official pills (Pilida Ferri Iodidi, TJ. S. and B. P.) each contain 
I of a grain (0.01) of reduced iron and ± of a grain (0.075) of iodine, 
and are given in the dose of one to three pills. 

Lactate of Iron. 

The Lactate of Iron (Ferri Lactas, TJ. S.) is soluble in 48 parts 
of water, and is given in the dose of 5 grains (0.35). It is used for 
the same purposes as the other preparations of iron. Lactate of iron 
is one of the ingredients of Syrupus Hypophosphitum cumFerro, TJ. S., 
the dose of which is J to 1 fluidrachm (2.0-4.0). 



228 DRUGS. 

Perri Subsulphas, or Monsel's Salt. 

Monsel's Solution (Liquor Ferri Subsulphatis, U. #.), sometimes 
wrongly called the Solution of the Persulphate of Iron, is one of the 
most powerful styptics or haemostatics that we have. It is never to 
be employed where a hemorrhage is to be attacked through the circu- 
lation, but only when the solution can come in direct contact with the 
bleeding spot. The objection to its use is the heavy, black, and dirty 
clot which it forms on coming in contact with the blood. In hoemop- 
tysis Monsel's solution should be used in fine spray consisting of from 
10 to 60 drops (0.65-4.0) to the ounce of distilled water. In uterine 
hemorrhage from any cause the dilution may be half-and-half, or if 
the hemorrhage be from a polypus or the cervix uteri, the pure solu- 
tion should be used, locally applied. In nose-bleed Monsel's solution 
may be employed diluted one-half or pure, but it is disagreeable 
because of the hard, black clot which is formed and the uncomfortable 
sensations and pain produced in the nasal chambers. Plugging the 
nostrils with pledgets of cotton is generally sufficiently efficacious. 

In the intestinal hemorrhage occurring during or after typhoid 
fever Monsel's solution has been given, but ought not to be, as it is 
decomposed in the stomach before it reaches the intestine. Monsel's 
salt (Ferri Subsulphatis, U. S.) should be given in pills of 3 grains 
(0.15) each, the pills being made hard enough to escape into the 
intestine before the stomach breaks them down. One, two, or three 
pills may be given and repeated in an hour. Hosmatemesis due to 
bleeding in the stomach should be treated by 3-drop (0.15) doses of 
the solution in a little water. 

In tonsillitis and pharyngitis a most efficient application is pure 
Monsel's solution applied by means of a pledget of cotton or camel's- 
hair brush, or equal parts of the solution and glycerin may be used. 
This application is often as painful as it is efficient. In diphtheria 
this method of treatment is often of great service. The antidote to 
Monsel's solution is common soap. 

Oxalate of Iron. 

Oxalate of Iron (Ferri Oxalas) is given in the dose of 2 to 3 
grains (0.1-0.15). 

Phosphates of Iron. 

There are two phosphates of iron — Ferri Phosphas Solubilis, U. S. 
and B. P., and Ferri Pyrophosphas Solubilis, U. S. Phosphate of 
iron itself is very insoluble and is rarely used. The official forms 
are, however, quite soluble, and useful in the dose of 2 to 5 grains 
(0.1-0.35). Syrupus Ferri Phosphatus, B. P., is given in the dose 
of 1 fluidrachm (4.0). Phosphate of iron is one of the ingredients of 
the syrup of iron, quinine, and strychnine (Syrupus Ferri, Quinino? 
et Strychnince Phosphatum, U. S.), and is given in the dose of 1 
fluidrachm (4.0). 

Reduced Iron.- 

Quevenne's Iron (Ferrum Beductum, U. S. and B. P.) is an iron- 



IRON. 229 

gray or reddish powder which is frequently adulterated with lamp- 
black. If it is pure it should burn in sparks when dropped into a 
flame, but if lampblack is present this will not occur. It should also 
yield no sulphuretted hydrogen on adding sulphuric acid to it. It is 
tasteless, and may be given to children for this reason in pills or 
gum-drops, or placed inside of small chocolate creams, or in the form 
of troches {Trochisci Ferri Redacti, B. -P.), each lozenge containing 
1 grain (0.05) of the reduced iron. It is used solely in anaemia, and 
is one of the least astringent of the iron preparations. 

Sulphate of Iron. 

Sulphate of Iron {Ferri Sulphas, TJ. S. and B. P.) is used inter- 
nally in the dose of 5 grains (0.35) in pill form in chronic diarrhoea. 
Externally, in a solution of the strength of 5 to 25 grains to the 
ounce (0.35-1.65 : 32.0), it is used as an astringent lotion. Two 
other forms of the sulphate are also employed — namely, the dried 
{Ferri Sulphas Fxsiccatus, TJ. S. and B. P.) and the granulated 
(Ferri Sulphas G-ranulatus, TJ. S. and B. P.), each of which is given 
in the dose of 3 grains (0.18). 

Valerianate of Iron. 

Valerianate of Iron {Ferri Valerianas, TJ. S.) is sometimes useful 
in hysteria with anaemia, given in the dose of 1 grain (0.06) or more. 

Wines of Iron. 

The Bitter Wine of Iron ( Vinum Ferri Amarum, B. P.) is useful 
in ancemia, both in children and adults, and may be advantageously 
accompanied with cod-liver oil. It is given in a dose of 1 to 2 fluid- 
drachms (4.0-8.0) or more. This wine is composed of soluble citrate 
of iron and quinine, tincture of sweet orange-peel, syrup, and stronger 
white wine. 

Wine of the Citrate of Iron, or Vinum Ferri Citratis, TJ. S., is 
composed of the citrate of iron and ammonium, tincture of sweet 
orange-peel, syrup, and stronger white wine. The dose is identical 
with that of the bitter wine, and it is used for the same purposes. 

Hydrated Peroxide of Iron {Ferri Peroxidum Hydratum, B. P.) 
is used in the dose of 5 to 30 grains (0.35-2.0). From the last prepa- 
ration iron plaster {Emiplastrum Ferri, B. P.) is made. The plaster 
of iron official in the TJ. S. is prepared from the hydrated oxide of iron. 

The following preparations of iron are also official : Liquor Ferri 
Acetatis, TJ. S., dose 15 minims to 1 fluidrachm (1.0-4.0), and Liquor 
Ferri Acetatis Fortior, B. P., dose 1 to 8 minims (0.05-0.6). 

Untoward Effects of Iron. — Iron is apt to cause gastric distress and 
frontal headache in persons who are susceptible to its use. Even one 
dose will cause this trouble in some persons. In many instances the 
frontal headache will be found to be due to the constipation which 



230 DRUGS. 

has been brought on by the iron, and will be relieved if mild laxa- 
tives or purges are used. The state of the bowels should always be 
watched and laxatives given whenever constipation is present and 
iron is being administered. In rheumatic and gouty persons frontal 
headaches are a common symptom when iron is given, and purgatives 
will not generally give relief. Garrod and Haig have shown that 
iron decreases the elimination of uric acid, which may account for 
the production of headache in the case of rheumatic patients under 
its influence. Sometimes salts of iron produce vesical irritation and 
a constant desire to urinate, causing mucus to form in abnormal 
amount in the bladder. In children its use may result in nocturnal 
incontinence of urine. 

JALAP. 

Jalap (Jalapa, U. S. and B. P.) is the root of Ipomoea Jalapa, 
a native of Mexico. It contains two resins, jalapin and convolvulin, 
neither of which is used in medicine by itself, though both of them 
enter into the Resin of Jalap of the U. S. P. In overdose jalap or 
its resin causes vomiting and purging, with gastro-enteritis. 

Therapeutics. — Jalap is used in medicine as a hydragogue purge 
to relieve dropsy of any origin. It may be used to deplete in cases 
of general plethora with cerebral congestion, and owing to its tasteless- 
ness is a useful cathartic in children if given in the proper dose — 
namely, 1 to 2 grains (0.05-0.10) in J an ounce of syrup of rhubarb. 
Combined with calomel, it is preferred to all other purges by some 
practitioners, particularly if the liver is torpid. 

Administration. — Jalap may be given in the form of the compound 
powder (Pulvis Jalapce Compositus, U. S. and B. P.), dose 15 to 40 
grains (1.0-2.65), which is composed of 35 parts of jalap and 65 
parts of bitartrate of potassium ; and the resin (Resina Jalapce, 
U. S. and B. P.), dose for an adult 2 to 4 grains (0.1-0.2). Owing 
to the small size of the dose of the resin and its lack of taste, this 
preparation is to be preferred for children in the dose of J to J a 
grain (0.016-0.03). The tincture (Tinctura Jalapce, B. P.) is given 
in the dose of J to 1 fluidrachm (2.0-4.0); the extract (Extractum 
Jalapce, U. S. and B. P.) is used in the dose of 5 to 15 grains 
(0.35-1.0). 

JEQUIBITY. 

This is a plant known as Abrus Precatorius, the seeds of which 
are poisonous when applied to a wound. An active principle, abrin, 
is composed of paraglobulin and a-phytalbumose, which closely resem- 
ble snake-venom in their action. Jequirity is never used internally 
in medicine in this country. An infusion of the powdered seeds, 
made by adding \ a drachm to an ounce (2.0 : 32.0) of water at 140° 
F. is to be painted with a brush on the inside of the eyelids in cases 
of chronic granular conjunctivitis, in order to produce an acute diph- 
theritic inflammation which will so change the chronic process present 
as to permit of a cure. If an excessive action is developed, it may 



KAMALA. ' 231 

be controlled by hot compresses made of very dilute solutions of cor- 
rosive sublimate. The solution undergoes decomposition with great 
rapidity, and should be prepared freshly each time it is used, or 4 to 
8 grains (0.2-0.5) of boric acid should be added to preserve it. The 
drug is a powerful cardiac depressant poison when injected into the 
circulation. Whether the seeds produce poisoning when swallowed is 
doubtful, some asserting that they cause gastro-enteritis, others that 
they are harmless. Probably much depends on the activity of diges- 
tion at the time of ingestion. 



JUNIPER. 

Juniperus is the fruit or berry of Juniperus Communis, an ever- 
green of Northern Europe and America. It contains a volatile oil 
and an amorphous principle, juniperin. 

Physiological Action. — Juniper acts as a gastric stimulant and 
tonic, as a mild diaphoretic if combined with alcohol, and as a 
marked stimulating, exciting diuretic. It escapes from the body by 
the kidneys. 

Therapeutics. — Juniper is valuable as a stimulant to the genito- 
urinary system whenever it is depressed or chronically diseased, as 
in chronic pyelitis, nephritis, and chronic catarrh of the bladder. In 
congestion of the kidneys, if not accompanied by active tissue-changes, 
it relieves these organs and does away with albuminuria. Used after 
an attack of acute BrigMs disease when reaction has set in and the 
secreting epithelium of the kidney is atonic, it is of value, but care 
should be taken that all inflammation has passed by or it will make 
the patient worse. In the later stages of scarlet fever, in which the 
renal condition corresponds to that just described, juniper is useful. 
In old persons a sensation of weight across the lumbar region is often 
readily removed by the use of juniper if the kidneys are inactive. 

Administration. — Juniper is used in the form of the compound 
spirit (Spiritus Juniperi Compositus, U. S.), composed of the oils of 
juniper, caraway, and fennel, combined with alcohol and water, in 
the dose of 1 to 4 drachms (4.0-16.0). Gin is virtually identical 
with the compound spirit. The infusion of juniper is made by add- 
ing an ounce (32.0) of the berries to a pint (J a litre) of boiling water 
and allowing it to stand in a warm place for an hour. The entire 
quantity is to be taken in twenty-four hours, and the infusion is often 
combined with acetate of potassium or an ounce (32.0) of the bitar- 
trate of potassium in the treatment of dropsy. The spirit (Spiritus 
Juniperi, U. S. and B. P.) is given in the dose of 30 minims to 1 
drachm (2.0-4.0). The oil (Oleum Juniperi, U. S. and B. P.) is 
used in the dose of 1 to 4 minims (0.06-0.3). 



KAMALA. 

Kamala, U.'S. and B. P., or Rottlera, as it is sometimes called, 
is the hairs and bristles from the capsules of Mallotus philippiensis, 



232 DRUGS. 

a plant of Abyssinia, India, and China. It contains an active prin- 
ciple, rottlerin, which is not official. Given in the dose of 1 to 2 
drachms (4.0-8.0), kamala acts as a drastic and as a remedy for tape- 
worm. It should be administered in syrup, and repeated in eight 
hours if no effect is produced. (See Worms.) 



KAOLIN. 

Kaolin is a soft white powder, a decomposition-product of mineral 
deposits containing feldspar. It is used externally as a dusting pow- 
der in eczema. 

KINO. 

Kino is the inspissated juice of the Pterocarpus Marsupium, a 
tall tree of India. It contains kino-tannic acid, and is used as an 
astringent in serous diarrhoea. It is official in the form of the tinc- 
ture (Tinctura Kino, U. S. and B. P.), and is given in the dose of 1 
fluidrachm (4.0). Kino may be used as a gargle in sore throat and 
for relaxation of the uvula. Under the name of Compound Powder 
of Kino (Pulvis Kino Compositus, B. P.) an efficient and pleasant 
antidiarrhoea powder is used. This powder is not official in the 
U. S. P. The formula for each powder is 15 grains (1.0) of pow- 
dered kino, 4 (0.2) of powdered cinnamon, and 1 (0.05) of powdered 
opium. 

KOLA. 

This drug is the nut of Kola acuminata, a tree growing in certain 
parts of Africa. The nut depends for its chief medicinal activity 
upon the caffeine which it contains. In addition to this alkaloid it 
contains some theobromine and kolatannic acid, which latter ingredi- 
ent may explain the good results which have followed the use of kola 
in cases of diarrhoea. 

Physiological Action. — The physiological action of kola is, as far as 
we know, nearly identical with its near relatives coffee and coca. 

Therapeutics. — In cases of feeble heart associated with general debil- 
ity kola often proves a valuable stimulant to the heart and general sys- 
tem, as well as to the kidneys. It has also been used with asserted 
success in sea-sickness and to sober drunken persons, although the 
latter power is to be doubted, Its use will sometimes relieve sick 
and neuralgic headache. 

Administration. — Kola is not official. It may be given in the form 
of the fluid extract (Kxtractum K0I02 Fluidum), dose 10 to 30 
minims (0.65-2.0), or in an elixir. 

LANOLIN. 

Lanolin, which is practically the Adeps Lanai Hydrosus of the 
U. S. and B. P., is a fat derived from the wool of the common sheep, 
and is a whitish substance of peculiar stability, very difficult of 



LEAD. 233 

saponification, and incapable of becoming rancid. Unna states that 
ointments of acids, hydrogen peroxide, and other substances may be 
made by it. One great objection to lanolin is its stickiness, which is 
avoided by adding one-third of vaseline. Lanolin is supposed to 
possess very remarkable penetrating powers when applied to the skin 
in cases where much infiltration is present, particularly if it is com- 
bined with resorcin or some similar medicament. In itself it has 
little curative power, and is but little better than lard, suet, or any 
common fat as a basis for ointments. In some cases', which are rare, 
it will cause irritation of the skin. 



LEAD. 

Plumbum, or Lead, is a metal possessing more or less power over 
the organism according to the salts which are employed. It is not 
official as lead itself. 

Physiological Action. — Lead in one of its soluble salts, if applied 
to a mucous membrane, produces a bleaching which is particularly 
noticeable where the redness of inflammation has previously existed. 
It has little effect in single dose, except by an indirect influence over 
the circulation, nervous system, or respiration. (For a description of 
the effects of lead in overdoses see "Poisoning," below.) 

The most irritant and poisonous salt is the nitrate, the next the 
subacetate, and the least poisonous of the soluble salts is the acetate. 

Acute Poisoning. — When the acetate of lead is taken in poisonous 
amounts, it produces a sweet metallic taste in the mouth, followed by 
pain in the epigastrium and the vomiting of white, milky-looking 
liquids or white curds mixed with food. The white color is due to 
the presence of chloride of lead formed by the action of the gastric 
juice. 

The pain continually increases, and diarrhoea due to gastroenter- 
itis may be set up, or, in other cases, obstinate constipation is present. 
The passages are generally black, this being due to the presence of 
the sulphide of lead. At the same time the pulse becomes rapid, 
tense, and cord-like, but after a time weak and compressible. The 
face is anxious and pale or livid. The thirst is excessive, and cramps 
in the calves of the legs or muscular twitchings may ensue. It is 
said that the characteristic blue line on the gums may occur in acute 
poisoning, but this is not based on fact. If coma comes on, death 
is assured. 

The treatment consists in the use of the chemical antidote, a sol- 
uble sulphate, in large quantity, in the administration of emetics, and 
the use of the stomach-pump if the vomiting produced by the drug is 
not sufficient to rid the stomach of all the poison. The best soluble 
sulphates to employ are Epsom and Glauber salts, because they are 
always at hand, are readily soluble, and, in excess, act as purges, 
which will wash out the intestinal canal. Hot applications should be 
applied to the belly and feet, and the pain and irritation which is 
present relieved by opium. 



234 DRUGS. 

Chronic Poisoning. — Chronic lead poisoning is rarely produced by 
the soluble salts of lead, nearly always being due to the insoluble 
salts. The symptoms of chronic lead poisoning, or plumbism, are as 
various as it is possible to find variety in the signs of disease of every 
kind. There is no train of symptoms which may not occur, and the 
occurrence of rare, anomalous symptoms in a given case should at 
once bring to the mind the thought of lead poisoning or syphilis. 
Chronic poisoning occurs in painters, manufacturers of lead salts, and 
every one who is largely thrown in contact with the metal in the arts. 
It occurs from the use of hair-dyes containing the acetate of lead, 
from drinking water which has passed through new lead pipe, and 
even from the biting of silk threads loaded with lead to increase their 
weight. Chromate of lead has been used to color sponge-cake when 
eggs were thought too dear, and has killed many persons. Millers 
who have filled the holes in grindstones with lead have caused wide- 
spread epidemics of what has been called "dry cholera," and many 
persons have suffered from lead poisoning from eating apple-butter 
kept in jars glazed with lead. 

One of the most prominent, but by no means the most constant, 
symptoms of chronic plumbism is bilateral wrist-drop, due to palsy 
of the extensor muscles of the forearm. The short extensor of the 
thumb generally escapes the drug's influence, as does also the supi- 
nator longus. Sometimes internal squint arises from paralysis of the 
external rectus muscles. Another very common symptom is colic 
centring around the umbilicus and radiating through the belly and 
loins. Obstinate constipation often accompanies these symptoms, 
and the faeces, when passed, are white and clay-colored. 

During an attack of lead colic the arterial tension is increased very 
markedly, the tongue is coated and whitish, and the bowels are obsti- 
nately confined. 

If these early warnings are disregarded and the exposure to the 
lead is continued, cerebral symptoms come on, the result of eneeph- 
alopathia saturnina, or saturnine cerebritis. Saturnine epilepsy is 
not very rare. If convulsions come on, death generally ensues. 
The convulsions in some cases are not due to a cerebral effect of 
the lead, but to uraemia from the renal changes which it has 
caused. 

Renal disease is very commonly produced by lead, and it is not 
uncommon for chronic contracted kidney to be found at the autopsv 
of a sufferer from lead poisoning. If a patient with chronic lead 
poisoning have a urine with a persistent low specific gravity, the prog- 
nosis is grave as evidencing advanced kidney involvement. 

Asthma due to the inhalation of lead-dust is sometimes met with. 

The most important confirmatory evidence of chronic lead poisoning 
is a blue line on the gums just where they join the teeth. Its absence is 
not a negative sign, however, as poisoned persons cleanly in respect to 
their mouths often do not have it. Marked cachexia or anaemia is 
commonly seen in chronic lead poisoning. 

After prolonged lead-poisoning the nerve-trunks are found atro- 
phied, and finally changed into fibrous cords. Anterior poliomyelitis 



LEAD. 235 

may be present, but true locomotor ataxia is rarely caused. If 
ataxic symptoms exist, they are most probably dependent on pseudo- 
tabes produced by a plumbic multiple neuritis, and can be separated 
from true tabes dorsalis by the absence of several of the important 
true tabetic symptoms — namely, slow onset, absence of Argyll-Robert- 
son pupil, etc. — and the presence of marked wasting and loss of 
power, with tenderness over the nerve-trunks. 

In some cases trophic changes in the joints ensue, and plumbic 
gout is not rarely seen, or even lead arthralgia with deposits of urates 
in the joints. This condition is due to the fact, pointed out by Gar- 
rod and Haig, that lead forms insoluble salts with uric acid. 

Lead escapes from the body in the urine, the faeces, and all the 
secretions. It is chiefly eliminated by the liver and the bile. 

Treatment of Chronic Poisoning. — The treatment consists in 
three classes of remedial measures : 1st, the removal of the cause ; 
2d, the removal of the poison in the body; and, 3d, the treatment of 
the lesions produced by the poison. 

In lead colic hepatic purges, such as jalap and calomel, combined 
with opium to prevent pain, are indicated, and alum and opium or 
morphine are said to be almost specifics, the alum in 2-grain doses, 
the others in full amounts. In many cases purges fail to move the 
bowels of a person suffering from chronic lead poisoning, and succeed 
only when morphine is given to overcome the intestinal inhibition 
produced by the irritation caused by the lead. 

In the cerebral inflammation of lead-poisoning a blister to the back 
of the neck, revulsives, and a pilocarpine sweat may be resorted to. 

To aid in the elimination of the lead, iodide of potassium, which 
forms double soluble salts in the tissues with the metal, is to be used, 
10 to 20 grains (0.65-1.3) three times a day. 

If progressive paralysis is present, Wood insists on the use of 
large doses of strychnine at the same time that the iodide is given. 
The strychnine should not, of course, be given with the iodide, as it 
is incompatible. 

Electricity should be used as a remedy to restore lost function. 
If the faradic current makes the muscles contract, it should be 
employed, and, if not, the galvanic should be used. Curiously 
enough, voluntary power sometimes returns before the muscles will 
react at all to electricity. 

It is said that baths of sulphuret of potassium should be used, 5 
or 6 ounces (160.0) of the salt to each bath, which is to be given in a 
wooden tub. The patient should afterward be well soaped, then 
thoroughly rinsed off, and rubbed down with a rough towel. 

As the salts of lead are used for different purposes, the therapeu- 
tics of each one will be taken up separately. 

Acetate of Lead. 

Acetate of Lead (Plumbi Acetas, U. S. and B. P.), or Sugar of 
Lead, has a sweet, astringent taste, and is soluble in water, although 
the solution formed is slightly milky in appearance. 



236 DRUGS. 

Therapeutics. — Acetate of lead may be used, and is largely 
employed, in the following pill in the treatment of serous diarrhoea: 

R .—Plumbi acetat gr. xl (2.65). 

Pulv. opii gr. x (0.65). 

Camphor* gr. xl (2.65).— M. 

Ft. in pil. No. xx. 
S. — One every four hours. 

This pill may also be given in dysentery. 

Administration. — The B. P. recognizes the following preparations 
of lead acetate: Pilula Plumbi cum Opio, dose 3 to 5 grains (0.1- 
0.3); Suppositoria Plumbi Composita, each suppository containing 1 
grain (0.06) of opium to 3 grains (0.18) of lead acetate ; and an oint- 
ment ( Unguentum Plumbi Acetatis). 

Carbonate of Lead. 

Carbonate of Lead [Plumbi Carbonas, U. S. and B. P.), or White 
Lead, is insoluble, and is used as a coating or dressing for burns, 
scalds, or ulcers when rubbed up with linseed or other oil, or in the 
form of the ointment ( Unguentum Plumbi Carbonatis, U. S. and 
B. P.). If a wide surface is covered with this ointment, it may 
cause lead poisoning by absorption. 

Carbonate of lead may be used in the treatment of sunburn in the 
following prescription : 

R. — Plumbi carbonat £j (4.0). 

Pulv. amyli 3j (4.0). 

Unguent, aquae rosa? ,^j (32.0). 

Olei olivse %ij (8.0).— M. 

S. — Apply to the inflamed skin. 

Iodide of Lead. 

Iodide of Lead (Plumbi Iodidum, U. S. and B. P.) is occasion- 
ally employed in medicine; the dose is J to 2 grains (0.03-0.1). 
Emplastrum Plumbi Lodidi, P. B., and Unguentum Plumbi Lodidi, 
U. S. and B. P., are useful as external astringent and alterative 
applications. 

Liquor Plumbi Subacetatis. 

Liquor Plumbi Subacetatis, U. S. and B. P., or Goulard's Extract, 
is a colorless liquid, much used externally, when diluted with lauda- 
num, for sprains, bruises, and local inflammations, under the name of 
"lead-water and laudanum." u L. and L.," as it is often called in 
the hospitals, is a useful application in the dermatitis produced by 
poison ivy. The proportion should be 4 parts of the pure lead-water, 
diluted with 16 parts of water, to 1 of laudanum, but this is varied 
as the inflammation or pain is the more severe. The official liquor 
is also official in a dilute solution (Liquor Plumbi Subacetatis Dilutus, 
U. S. and B. P.), and as such is too weak for ordinary use, although 
it is commonly employed. The strong solution should be used in the 



LEPTANDBA. 237 

strength of from 1 to 4 ounces (32.0-128.0) to the pint (500 cc.) of 
water. This solution should never be employed if the skin is broken, 
as absorption may occur, and, what is more important still, the drug 
prevents healing by constringing and whitening the edges of the 
wound. If some bread-crumbs be saturated with this solution and 
applied to an inflamed finger, a felon can often be aborted in the 
early stages. The official dilute solution is useful as a lotion in 
eczema which itches and tingles and is not dry in character. It 
should be applied once or twice a day, and it is well to follow the 
application of the lead with a weak sulphur bath or alkaline wash. 
(See Eczema.) 

Lead-water is also useful in pruritus pudendi, and the acetate of 
lead may be used as an injection in the dose of 1 to 8 grains (0.06- 
0.5) to the ounce of water in cases of gonorrhoea. The cerate (Cera- 
tum Plumbi Subacetatis, U. S.), the liniment (Linimentum Plumbi 
Subacetatis), and the glycerin (Grlycerinum Plumbi Subacetatis, U. S. 
and B. P.) may be used for the same purposes as the Goulard's 
extract. 

Litharge. 

Litharge {Plumbi Oxidum, U. S. and B. P.) is used for the prep- 
aration of lead plaster (Bmplastrum Plumbi, U. S. and B. P.), some- 
times called " Diachylon," and this is in turn employed for the manu- 
facture of resin plaster (Bmplastrum Besince, U. S. and B. P.). It 
is also used in the preparation of the solution of subacetate of lead. 

Hebra recommends for sweating of the feet an application of equal 
parts of lead plaster and linseed oil, applied on linen and wrapped 
around the feet every third day. 

Nitrate of Lead. 

Nitrate of Lead {Plumbi Nitras, U. S. and B. P.) is never used 
internally, but as a powder, in the treatment of cases of onychia 
maligna and in the formation of Ledoyen's disinfecting solution. 
The latter discolors the paint in water-closets, dissolves the solder in 
drain-pipes, and is not a good preparation for general use. 



LEPTANDRA. 

The medicinal portion of Veronica Virginica is the rhizome and 
rootlet, from which are made the official extract {Extractum Leptan- 
dro?, U. S.) and the fluid extract (Bxtr actum Leptandrw Fluidum, 
U. S.). The dose of the former is from 1 to 8 grains (0.06-0.5) and 
of the fluid extract 5 to 40 minims (0.3-2.6). 

Physiological Action. — Very few experiments have been made as 
to the action of this remedy, and the only ones of importance are 
those of Rutherford and Signal, who found that it possessed a mod- 
erate influence in increasing the flow of bile. In overdose it causes 
violent purging. 



238 DRUGS. 

Therapeutics. — In the official preparations of leptandra, which are 
not as active as is the fresh drug, we have excellent substitutes for 
calomel, according to many clinicians. Those who have used leptandra 
also believe it to be of the greatest value in the indigestion of the 
intestinal type sometimes called " duodenal atony." The following 
pill is a good method of using the drug in these cases : 

R. — Ext. chirettae gr. xx (1.3). 

Ext. leptandrse gr. xx (1.3). — M. 

Ft. in pil. No. x. 
S. — One pill after each meal. 

Under the name of leptandrin we have an impure resin which is 
given in the dose of 2 to 5 grains (0.1-0.3). An alkaloid of doubtful 
existence is called leptandrine. 



LIPANIN. 

Lipanin is an artificially prepared mixture devised by Von Mering 
as a substitute for cod-liver oil, and consists in 6 parts of oleic acid 
added to 100 parts of olive oil. The advantages possessed by it are 
its lack of disagreeable odor and taste and its ready emulsification 
and digestibility. The commencing dose is 1 drachm (4.0) which 
may be increased to 4 drachms (16.0). This mixture has been found 
of value in most of the diseases in which cod-liver oil is employed, 
and in the opinion of the author its efficacy is greatly increased if 
the hypophosphites of lime and sodium are used at the same time in 
the dose of 10 grains (0.65) three times a day. Iodine or one of its 
compounds may also be given if it is desired to exert an alterative 
influence. 

LIQUORICE. 

Liquorice (GlycyrrMza, TJ. S. ; Glycyrrhizce Radix, B. P.) is the 
root of Glycyrrhiza Glabra, a plant of Southern Europe and Asia. 
It is used to increase secretion in the mouth in the form of a solid 
extract, and when dissolved in water to form a vehicle for other drugs, 
particularly if they have a disagreeable taste. The powdered solid 
extract is a very mild and useful laxative. 

Administration. — The solid extract (Extractum Glycyrrhizce, TJ. S. 
and B. P.) is used in a dose anywhere from 5 to 120 grains (0.35- 
8.0). The pure extract {Extr actum Glycyrrhizce Purum, TJ. S.) is 
used in the same quantities as the ordinary extract. The fluid extract 
[Extr actum G-lycyrrhizce Fluidum, TJ. S.) or the liquid extract [Extr ac- 
tum Glycyrrhizce Liquidum, B. P.) is used in 1- to 2-drachm (4.0-8.0) 
doses. Under the name of Brown Mixture or " Compound Liquorice 
Mixture " a very efficient expectorant solution is official (Mistier a 
Glycyrrhizce Composita, TJ. S.), which contains as its most important 
ingredients 12 parts of paregoric, 6 parts of wine of antimony, and 
3 parts of sweet spirit of nitre. The dose is 1 to 4 drachms (4.0- 
16.0). Pulvis Glycyrrhiza Composita, TJ. S. and B. P., or compound 



LITHIUM. 239 

liquorice powder, contains, according to the TJ. S. P., 18 parts of 
senna, 16 of liquorice, 8 of fennel, 8 of washed sulphur, and 50 parts 
of sugar. According to the B. P., it should contain 2 parts of senna, 
2 of liquorice-root, 1 of fennel-fruit, 1 of sublimed sulphur, and of 
sugar 6 parts. The dose is 1 to 4 drachms (4.0-16.0). It is largely 
used as an efficient laxative after childbirth and in cases which suffer 
from constipation chiefly due to the inactivity consequent upon being 
in bed. The troches (Trochisci Grlycyrrhizce et Opii, TJ. S. and 
B. P.) contain -^ grain (0.003) of opium and 2 grains (0.1) of extract 
of liquorice. Finally we have Giycyrrhizinum. Ammoniatum, TJ. S., 
which is the sweet principle of liquorice rendered soluble and easily 
tasted by the addition of ammonia. The dose of this preparation is 
5 to 15 grains (0.3-1.0). 



LIQUOR POTASSJE. 

Liquor Potassce, TJ. S. and B. P., is a solution of potassa contain- 
ing about 5 per cent, of potassium hydrate, and is a clear, odorless 
liquid of caustic taste and strongly alkaline reaction. It is used in 
medicine as an antacid and for the purpose of decreasing the acidity 
of the urine. 

In ingrowing toe-nail it is often used to soften the nail prior to 
packing with cotton or partial evulsion. Its dose is 5 to 30 drops 
(0.35-2.0) well diluted with water. 



LITHIUM. 

Lithium is used in several forms, but its salts may be divided into 
two classes — those which act as lithium and those which act as the 
acids forming them. In the first class we have the carbonate {Lithii 
Carbonas, TJ. S. and B. P.), dose 2 to 10 grains (0.1-0.65), the citrate 
[Lithii Citras, TJ. S. and B. P.), dose 5 to 20 grains (0.3-1.3), and 
the effervescent citrate (Lithii Oitras JEffervescens, TJ. $.), dose 1 to 4 
drachms (4.0-16.0). In the second class we find the benzoate {Lithii 
Benzoas, TJ. $.), dose 5 to 30 grains (0.3-2.0); Lithii Bromidum, 
TJ. S., dose 10 to 40 grains (0.65-2.65), and Lithii Salicylas, TJ. S., 
dose 10 to 30 grains (0.65-2.0), 

Haig has pointed out that although lithia forms salts with uric 
acid in the test-tube, in the body it has a greater affinity for the acid 
sodium phosphate in the blood, and practically leaves the uric acid 
to itself. This is an important point, since it proves that the large 
amount of water generally taken with lithia has more to do with 
relieving gout than has the lithia. 

The carbonate and citrate are used in gout and rheumatoid arthri- 
tis for the purpose of entering into combination with the uric acid in 
the body to form soluble urates and prevent deposits in the joints. 
They have been said to dissolve calculi, but this is untrue, though 
they are used when it is desired to render the urine alkaline. The 
carbonate is not soluble in water, and should be given in capsule or 



240 DRUGS. 

freshly-made pill, but the citrate is soluble. The latter may be made 
from the former by taking 50 grains (3.3) of the carbonate, 90 grains 
(6.0) of crystallized citric acid, and warm distilled water 1 fluidounee 
(32.0). The acid should be dissolved first, and the carbonate added 
to the solution. The solution should then be kept hot until efferves- 
cence ceases. 

In cases of diabetes depending upon a gouty taint remarkable 
results are often obtained from the use of the citrate or carbonate of 
lithium and arsenic. The dose should be -^ of a grain (0.002) of 
arsenite of sodium and 10 grains (0.65) of the lithium salt three times 
a day. 

(For the use of the other salts of lithium see the articles on the 
Bromides, Salicylic Acid, and Benzoic Acid.) 

It is worthy of note that in some cases citrate of lithium will dis- 
order the stomach and produce vomiting. Lithia-water, or the prepa- 
ration of the British Pharmacopoeia, Liquor Lithice Lffervescens, is 
useful in gout in quantities of 5 to 10 ounces (160.0-320.0) at a time. 



LOBELIA. 

Lobelia, U. S. and B. P., is the leaves and tops of Lobelia Inflata, 
a common Aveed of the United States. It contains an alkaloid, lobe- 
line, and lobelic acid. 

Physiological Action. — When taken in overdose lobelia causes erne- 
sis, intense prostration, a feeble pulse, pale skin, livid face, muscular 
relaxation, and a cold sweat. Violent purging may be present. It 
is said to paralyze the motor nerve-trunks, and it causes a fall of 
arterial pressure, followed by a rise, due to the asphyxia which it 
finally produces. Ultimately it paralyzes the respiratory centre and 
the peripheral vagi. The treatment of the poisoning is to administer 
opium to stop irritation and vomiting, to give alcohol and ammonia 
to support the heart, and in the use of external heat. 

Therapeutics. — Lobelia is used chiefly as an antiasthmatic, and has 
been equally praised and condemned by eminent authorities. The 
reason for this lies in the fact that it is generally useless in asthma 
unless given in almost poisonous dose. Wood teaches that it should 
rarety if ever be used, because of its poisonous effects even in doses 
medicinally active, while Sidney Ringer says that the drug is erro- 
neously thought to be dangerous. In asthma both of the gastric and 
bronchial form lobelia is undoubtedly of service. In some cases it 
fails as signally as it succeeds in others. If the asthma is due to or 
associated with cardiac disease, lobelia should never be employed. 
The drug should be taken in the dose of J a drachm (2.0) to 1 drachm 
(4.0) of the tincture at the first sign of an attack, or in 10-drop (0.65) 
doses every fifteen minutes until distinct nausea occurs or relief is 
obtained. 

In atonic constipation 10 drops (0.65) of the tincture at bed-time 
are often of service. 

Administration. — Lobelia is given in the form of the tincture {Tine- 



MAGNESIA. 241 

tura Lobelia, U. S.), in the close of 10 to 30 drops (0.65-2.0), or 1 
to 2 drachms (4.0-8.0) as an emetic. The vinegar (Acetum Lobelice) 
is no longer official, but is given in the dose of 20 to 30 drops (1.65- 
2.0). and the fluid extract [Extractum Lobelice Fluiclum, U. S.) in 
the dose of 1 to 5 drops (0.05-0.35), or as an emetic in the dose of 
15 drops (1.0). 

In the form of the infusion lobelia is useful as a lotion in the treat- 
ment of the dermatitis produced b y poison ivy. The proportion used 
should be an ounce (32.0) to the pint (J litre) of water. 

The preparations of the B. P. are the Tinctura Lobelice, dose 10 
minims to \ drachm (0.65-2.0), and Tinctura Lobelice JEtherea, dose 
10 to 30 minims (0.65-2.0). 

LYCOPODIUM. 

Lycopodium, U. S., is a pale-yellow powder derived from Ly co- 
podium Olavatum, a species of moss. It is used by pharmacists as a 
powder in which to roll pills, and by physicians and nurses to prevent 
the intertrigo or chapping of the skin of infants and adults. 



LYSOL. 

This is a preparation made by dissolving in fat and saponifying 
with alcohol that part of tar oil which boils between 190° and 200° 
C, and is a brownish, clear, oily fluid, smelling somewhat like creo- 
sote. It is used for the same purposes as creolin, but possesses the 
advantage of forming a clear, soapy fluid, when mixed with water, in 
which instruments can be seen. If small instruments are used, the 
solution is too soapy and renders them slippery. Those who have 
used lysol claim that it does not affect the operator's hands except to 
render them soft and flexible. Experiment shows it to be possessed 
of marked antiseptic power, and it is far less poisonous than carbolic 
acid. Used upon mucous membranes, the solution should not be 
stronger than 2 per cent. 

MAGNESIA. 

Magnesia is the oxide of magnesium, made by exposing the car- 
bonate of magnesium to a red heat. It is used in the form of the 
light magnesia (Magnesia Levis) as a dusting powder. The troches 
(Troehisci Magnesice) each contain 3 grains (0.015). 

Magnesia is an antidote to arsenic, and when employed to precip- 
itate a soluble preparation of iron it forms the Antidotum Arsenici 
(Ferrum Oxidum Hydratum cum Magnesia, U. S.). 

It is important that the student should not confuse magnesia and 
magnesium. The first is the oxide of the second, and is sometimes 
called calcined magnesia or " Husband's Magnesia." Magnesia is of 
little value except as a feeble antacid. Magnesia and the carbonate 
of magnesium may be used interchangeably. 

16 



242 DRUGS. 

MAGNESIUM. 

Magnesium is a metal never used as such, but always in the form 
of one of its salts, which are the sulphate, citrate, carbonate, and 
sulphite. The sulphite is a natural salt found in sea-water and in 
caves or in the water coming from the latter. The citrate and car- 
bonate are derived from the sulphate. The carbonate is insoluble in 
water and alcohol. The others are soluble. 

Magnesium Carbonate. 

The Carbonate of Magnesium is official in the form of the heavy 
and light powder (Magnesii Carbonas Ponder osa, U. S. and B. P., and 
Magnesii Carbonas, U. S.; Magnesii Carbonas Levis, B. P.). These two 
substances do not differ in respect to their effects. The light mag- 
nesium is never given internally, because of its bulk, but it is used as 
a dusting powder in intertrigo, and in the form of white cubes rubbed 
on the skin to prevent excessive perspiration and as a cosmetic. The 
heavy magnesium is used as an antacid, and is not, as has been 
thought by some, in any sense a laxative, as it possesses no such 
power. When the stomach or intestines contain much acid from 
fermentative changes, these acids may, however, unite with the mag- 
nesium and form a slightly laxative salt. 

In sick headaches due to great gastric acidity carbonate of magne- 
sium is often of service. The dose of the carbonate is from 5 to 60 
grains (0.3-4.0). It should not be used constantly, as there is danger 
that it will accumulate in the intestines. 

Liquor Magnesii Carbonatis, B. P., is given in the dose of 1 to 
2 ounces (32.0-64.0) as a laxative. 

Magnesium Citrate. 

The Citrate of Magnesium [Magnesii Citras) is a much more irri- 
tating purge than the sulphate, but it is more agreeable to the taste. 
It is official in two forms, one of which is the solution (Liquor Mag- 
nesii Citratis, U. S. and B, P.), which is effervescent and should 
never be used unless freshly prepared. It is made by adding bicar- 
bonate of potassium to a syrupy solution of the citrate of magnesium 
containing an excess of acid, and corking the bottle tightly, the cork 
being tied down with a strong cord. Care should be taken that the 
bottle is a strong one. The dose is half to one bottle. It is too irri- 
tating to be used where inflammation of the alimentary canal exists, 
but is useful in the treatment of sick and bilious headache. 

The Granulated Citrate (Magnesii Citras Effervescens, TJ. S.) is 
less agreeable to take. It should be dissolved in water, about 1 to 3 
drachms (15.0-45.0) of the salt being used in each dose, and swal- 
lowed while the solution is effervescing. It must be kept in bottles 
tightly corked. 

Magnesium Sulphate. 

Sulphate of Magnesium (Magnesii Sulphas, U. S. and B. P.) 



MANNA. 243 

is a white granular powder of neutral reaction, salty taste, and is 
soluble in water. It is the form generally known by the laity as 
"salts," although in some parts of the country this also includes the 
sulphate of sodium. According to the studies of Hay and others, 
sulphate of magnesium is a purge by reason of its abstraction of 
water from the intestinal blood-vessels. All strong saline solutions 
above the strength of 7 per 1000 abstract liquids from the tissues 
when brought in contact with them. On the other hand, if a saline 
solution be less strong than 7 per 1000, it will abstract salts from the 
tissues and replace them with water. The recollection of these facts 
readily makes clear the mode of action of magnesium sulphate. When- 
ever a thorough purgative action is required — that is, where depletion 
of the intestine or absorption of exudations is to be attained — the mag- 
nesium should be given in concentrated form, so as to make its solu- 
tion of as high a percentage as possible. Magnesium sulphate may 
be given by enema with the double purpose of unloading the bowels 
and acting as a depletant. The best mixture for this purpose seems 
to be that proposed by Watkins — namely, 2 ounces (64.0) of magne- 
sium, 1 ounce (32.0) of glycerin, and 4 ounces (128.0) of water. 

In cases of dropsy the use of concentrated solutions is particularly 
necessary, and from 1 to 2 ounces should be given before breakfast or 
on an empty stomach in as little water as will dissolve the salt. (See 
Dropsy.) 

In enteritis and peritonitis this use of magnesium is widely recog- 
nized as a proper measure. The sulphate is not irritating, and may 
be given freely when inflammation exists. (See Peritonitis.) It forms 
a large part of most of the natural purgative waters. The B. P. 
recognizes an enema, Enema Magnesii Sulpliatis, composed of sulphate 
of magnesium 1 part, olive oil 1 part, starch mucilage 15 parts. 



MANGANESE. 

Manganum, or Manganese, is official in the form of the black oxide 
[Mangani Dioxidum, TJ. S. and B. P.) and the sulphate {Mangani 
Sulphas, TJ. S.). The first of these, under the name binoxide of 
manganese, has been highly praised in amenorrhea dependent upon 
functional disturbance and anaemia. The dose is 3 to 5 grains (0.15- 
0.3) three times a day, in pill form, and the drug should be taken 
for a few days before the expected or proper date for menstruation. 
The sulphate is rarely if ever employed, but may be tried in malarial 
jaundice. The dose is 1 to 2 grains (0.05-0.1). 



MANNA. 

Manna, TJ. S. and B. P., is the concrete juice of the exudation of 
Fraxinus Ornus, a tree of Europe. It occurs in small or large 
roundish masses, looking somewhat like a gray-colored gum arabic. 
It has a sweet taste and odor. Sometimes the taste is a little bitter. 



244 DRUGS. 

Therapeutics. — Manna is the most feeble of the laxatives, and 
causes a slight flatulence in some persons. In children fed by the 
bottle one of the most frequent disorders is obstinate constipation, and 
for its relief 1 to 2 drachms (4.0-8.0) of the sweet variety of manna 
may be dissolved in the milk of each bottle. When given to older 
children or adults, manna is always combined with other more power- 
ful drugs, chiefly to cover their taste. It may be combined with 
advantage with rhubarb and senna, and it enters into the official 
Infusum Sennce Compositum, U. S., the dose of which is from 1 to 4 
fluidounces (3.20-64.0). 

MATRICARIA. 

Matricaria, U. S., German Chamomile, consists in the flower-heads 
of Matricaria Chamomilla, a European plant, possessing mild tonic 
properties in moderate dose. In larger amounts it acts as an emetic 
and anthelmintic. In the form of an infusion of the strength of 1 to 
2 ounces to the pint (32.0-64.0 : \ litre) it has been largely used as a 
diaphoretic, and, in small doses, to prevent colic in teething children. 



MENTHOL. 
(See Peppermint.) 

MERCURY. 

Hydrargyrum, U. S. and B. P., Mercury or Quicksilver, is a 
heavy fluid metal of a peculiar color and appearance. As mercury 
it is used in medicine in the form of the ointment, the plaster, gray 
powder, and blue mass. 

Physiological Action. — When mercury is taken into the body in 
one of its insoluble and mild preparations, it may cause no evidence 
of its presence until by frequent dosage the system in general begins 
to feel its influence. The first evidences of this are to be found in 
the mouth, and consist in tenderness of the teeth when the jaws are 
firmly and quickly closed, foetid breath, sponginess of the gums, 
which finally may bleed at the slightest touch, swelling of the tongue, 
and, most prominent of all, excessive salivation, a condition some- 
times called ptyalism. If the use of the drug is persisted in, all 
these symptoms grow worse. Eczema, and finally sloughs of the chin 
and chest develop as the result of the constant dribbling of saliva 
and the direct depressing effect of the drug on the tissues. The teeth 
drop out, the maxillary bones undergo necrosis, and amid a general 
melting down and decomposition of the tissues the patient dies. The 
blood is affected, and becomes very thin, fluid, and poor in its corpus- 
cular elements. These symptoms ensue on the use of mercury in 
continued doses, and rarely follow exposure to the drug in the pro- 
cesses of the arts. In the arts — as, for instance, in the making of 



MERCURY. 245 

looking-glasses — workmen are often affected by various trains of 
symptoms varying very widely in their course. In some cases the 
nervous system becomes chiefly affected. Tremors of all sorts arise, 
paralysis agitans is developed with its typical characteristics, and 
widely different changes and degenerations in the spinal cord ensue ; 
but it is worthy of note that the ocular muscles are rarely involved 
in mercurial tremor, while in disseminated sclerosis nystagmus is not 
rare. Similarly the tremors of mercurial poisoning often affect the 
head and neck alone, while in paralysis agitans this is rarely the case. 
Chorea often comes on in chronic mercurial poisoning, and its occur- 
rence in an adult should cause inquiry as to any possible exposure to 
mercury. In other cases brownish discoloration of the skin, resem- 
bling Addison's disease, appears. Blindness, deafness, sensory dis- 
turbances, such as hyperesthesia and anaesthesia, are developed, and 
localized wasting of muscles or groups of muscles may assert itself. 
In still other cases the blood becomes impoverished and mercurial 
cachexia is developed. 

It is worthy of note that children under three years are rarely 
salivated by the use of mercury, but this is no reason for using this 
drug carelessly in this class of cases, since the other changes in the 
organism nevertheless occur. 

The question as to the form in which mercury finds entrance into 
the system is one of interest and importance. According to certain 
writers, it is changed into an albuminate, and so circulates in the 
blood, but, while this is probably true, it is not known to be a fact. 

Some have supposed that the bichloride is held in solution as 
an albuminate of the oxide of mercury united with sodium chloride, 
but others have asserted that metallic mercury in a state of minute 
subdivision circulates in the blood: this point, however, cannot be 
considered settled, and the drug undoubtedly accumulates in all the 
tissues, more especially in the liver and kidneys. 

Mercury in all its forms is absorbed and eliminated by the kid- 
neys, liver, skin, and salivary glands. No secretion of the body, 
even to the semen, fails to carry it out of the system, but it is to be 
remembered that, although these parts are actively engaged in its 
elimination, the drug nevertheless rapidly accumulates in the body. 

Balzer and Klumpke have made a long series of observations at 
the Lourcine Hospital in Paris on the rapidity of the elimination of 
mercury by the kidneys during a treatment of long standing. While 
there are many methods for the estimation of mercury in organic 
fluids, these investigators throughout adopted that of Witz, as modi- 
fied by Souchow and Michaelowsky, which permits of the easy detec- 
tion of the yJ-QQ of a grain (0.00006) in an ounce (32.0). After a 
single dose of mercury the elimination of the drug is rapid, and 
sometimes complete in twenty-four hours, but if a continuous treat- 
ment is interrupted, its excretion continues for some time, and Kuss- 
maul and Gorup-Besanez have found it in the liver as much as a year 
after its administration has been stopped. The amount of mercury 
that can be readily eliminated for many weeks from the kidneys when 
the body is saturated is about ^ of a grain (0.004) daily. 



246 DRUGS. 

Therapeutics. — The employment of mercury in medicine centres 
around four great points — viz. : 1st, its value in syphilis and kindred 
states; 2d, its use as a purge; 3d, its power as an antiseptic and 
germicide; and 4th, its action as an antiphlogistic: the first and 
fourth points are fulfilled by all the mercury salts more or less per- 
fectly, the second only by blue mass and calomel, the third by the 
bichloride and biniodide of mercury. 

In syphilis mercury is to be given, not because the patient shows 
symptoms of the secondary or tertiary type of the disease, but 
because the conditions present do or do not call for its emplovment. 
Many writers have insisted that it ought only to be employed in the 
secondary stages, and while this is, as a general rule, correct, certain 
conditions may call for it at any time. (See Syphilis.) 

Mercury is often administered by means of fumigations or inhala- 
tions both for the removal of local and general syphilitic disorders. 
The best apparatus for either purpose is one devised by Bumstead, 
and it is both simple and inexpensive. It consists of a sheet-iron 
cup so bent that the bottom of the vessel, instead of being flat, pro- 
jects into the centre of the cup, thereby forming a raised centre with 
a little ditch about it. The top of this projection is flattened, and on 
its apex is placed the calomel which is to be sublimed. The sur- 
rounding ditch is then filled with hot water, and the cup placed over 
an alcohol flame, which disengages the vapor of the calomel and 
water. 

When inhalations are used the face should be held some six or 
eight inches away from the cup to permit the fumes to pass through 
the air. Under these circumstances the quantity of calomel used 
should not exceed 4 or 5 grains (0.3), and the mouth should be rinsed 
out to prevent mercurial stomatitis unless a local action on the buccal 
mucous membrane is desired. Not more than eight or ten inspira- 
tions should be taken at one sitting. 

If general fumigations are to be practised, the patient places the 
lamp and cup with 30 grains (2.0) of calomel on it under a chair, on 
which he sits wrapped in a heavy blanket. 

We believe that the ultimate conclusion of the profession in regard 
to the hypodermic injection of mercurials in syphilis will certainly 
be identical with that governing its use of quinine in malarial fever. 
There can be no doubt that a certain number of instances do arise in 
which, by reason of severe infection, susceptibility of the patient, or 
inability to take mercury by the ordinary means, hypodermic injec- 
tions are absolutely necessary. In the same way that we give qui- 
nine by the mouth, the rectum, and hypodermically in pernicious 
malarial fever, so do we give mercury by the mouth, by inunctions, 
by sublimation, and by the hypodermic needle in malignant syphilis. 
The reasons for believing that hypodermic injections of mercurials 
are not to be resorted to as a routine treatment of syphilis are several. 
In the first place, all forms of hypodermic medication possess disad- 
vantages not possessed by the use of drugs by the mouth. There is 
always some danger of entering a vein, of producing an abscess, or 
of causing local pain. When mercurials are so employed, the danger 



MERCURY. 247 

of abscess, of pain, or of milder inflammatory manifestations is 
greatly increased, and the presence of an indurated spot where the 
hypodermic injection has been given proves that it is not the simplest 
form of medication in syphilis. Of the mercurial preparations which 
are best administered hypodermically in syphilis, the two which sur- 
pass all others are undoubtedly the bichloride of mercury, in the 
dose of \ grain, dissolved in 10 or 15 drops of distilled water, every 
second or third day, or gray oil {Oleum Cinereum), which was first 
introduced into medicine by Lang of Vienna. (See Gray Oil, under 
Mercury.) 

In all cases the injection should be given deeply and in some por- 
tion of the body in which the tissues are loose, as the buttock or the 
broad of the back. 

The employment of mercury as a purge or laxative having a 
special action on the liver is constantly resorted to. The two prepa- 
rations used are blue mass and calomel, but the latter is more active. 
They both cause soft and watery stools, according to the dose in 
which they are given, but the blue mass is rarely, if ever, used 
except for the production of a laxative effect. 

Much discussion has arisen as to whether mercury does affect the 
liver, and whether the peculiar greenish or brownish-yellow stools 
produced by it are due to the presence of bile or mercury. 

If there is one point firmly fixed in the mind of the average 
practitioner of medicine, it is that the mild chloride of mercury 
increases the quantity of bile in the intestine. If such a believer 
is questioned as to whether this increased amount of biliary fluid 
is due to a true increase in secretion or simply to an increase in 
the flow of bile from the gall-bladder, he will either state that he 
is unable to answer the question or that he believes that it is an 
increased secretion. 

Practically, the position of the profession in general in regard to 
the purgative influence of calomel is that the drug exercises a stim- 
ulating effect upon the biliary gland. Careful experimentation upon 
the lower animals by several competent observers, and careful studies 
made by physiological chemists, fail, however, to give us very much 
light upon this subject. It is held by some that calomel never acts 
as calomel, but is converted by the hydrochloric acid of the gastric 
juice into corrosive sublimate, and that this drug then stimulates the 
liver to increased activity. 

On the other hand, the best chemical investigations show positively 
that the feeble acidity of the gastric juice and the temperature to 
which the calomel is exposed are not favorable to the conversion of a 
sufficient quantity of calomel into corrosive sublimate to account for 
any hepatic influence. Thus it was found by Rutherford and Vignal, 
in their well-known series of studies upon the influence of drugs upon 
the secretion of bile, that if 5 grains of calomel are subjected, at 
100° F., for seventeen hours to the action of normal gastric juice, not 
more than -^ of a grain of mercuric chloride is produced. As calomel 
does not remain in the human stomach for more than a night at the 
utmost, and generally but a very few hours, it is not likely that as 



248 DRUGS. 

much as ^ of a grain of mercuric chloride is produced from the 
moderately large dose of 5 grains. 

In contradiction of this, Bucheim, Winkler, and others assert that 
no conversion whatever takes place at the temperature of the body, 
and Jaennel's later studies support this view. 

The other theory as to the change which takes place in calomel 
prior to its action upon the liver is that it escapes into the intestine, 
where it is decomposed and the gray oxide of mercury precipitated, 
which may, however, be held in solution by any fatty materials, which, 
being mixed with alkaline liquids, practically form soaps. It is thought 
by Wood and others that this is the more probable result, particularly 
in view of the fact that calomel acts more like blue mass than cor- 
rosive sublimate. Further than this, these opinions are confirmed by 
the fact, with which all of us are familiar, that the hepatic influence 
of calomel is much more positively asserted if at the same time small 
doses of the bicarbonate of sodium are administered. Under these 
circumstances the bicarbonate of sodium naturally diminishes, to some 
extent at least, the acidity of the gastric contents, and also directly 
or indirectly tends to increase the alkalinity of the contents of the 
duodenum. 

As if to increase the complexity of the problem, the studies of 
Rutherford and Yignal seem to prove conclusively that in the dog, 
at least, mercuric chloride has a direct stimulant effect upon the 
hepatic cells; whereas, calomel, while producing purgation by increas- 
ing the secretion of the intestinal glands, in no way increases the true 
secretion of bile ; and this would seem to indicate that, after all, the 
influence of calomel upon the liver is due to a very minute portion 
of it being changed into corrosive sublimate. Probably the truth of 
the matter is, that we have as yet no definite scientific explanation of 
how T calomel really does act. It may be that the solution of the problem 
lies in the hepatic influence exercised by the presence of minute quan- 
tities of corrosive sublimate, and the purgative effect produced by that 
portion of the calomel which has not been converted into the strong 
chloride of mercury. This is rendered the more likely in view of the 
fact that the corrosive sublimate has been found a feeble intestinal 
stimulant, while the calomel has been found to produce active purga- 
tion in dogs, without producing an increase in biliary flow, when the 
drug has been introduced into the duodenum. 

It has been suggested, too, that calomel itself may stimulate the 
bile-expelling mechanism, while the minute portion of corrosive sub- 
limate increases the secretion of the liquid ; and, again, that by means 
of the purgative effect that it produces certain substances which have 
been in the intestine are immediately removed, and, as a consequence, 
a depressant influence upon the hepatic cells no longer exists. 

While, at first sight, the argument seems a forcible one that a vast 
clinical experience in regard to calomel is far superior to any series 
of experiments on dogs, it is only just to remember that in the entire 
series of remedies supposed to produce an hepatic effect calomel is the 
only one which failed to influence the liver of the dog as the others 
influenced the liver of man. 



MERCURY. 249 

It is to be hoped that those physicians who have opportunities to 
examine persons suffering from biliary fistula will take the oppor- 
tunity, whenever it arises, of watching the influence of calomel upon 
the flow of bile from the fistulous opening. 

This subject also is of interest to the practical physician in rela- 
tion to the administration of calomel in compressed tablets or other 
preparations when mixed with what might be called excipients. Under 
these circumstances, if one of the excipients is bicarbonate of sodium, 
the tablet almost always undergoes a change and becomes of a gray 
color. Those who have used pills or tablets of calomel which have 
been kept for a long period of time seem to be universally in accord 
with the statement that they have lost the hepatic effect which a 
recently-prepared powder always possesses. Thus it has been fre- 
quently found that no biliary flow occurs under the use of stale tab- 
lets, whereas free bilious purging follows the administration of freshly- 
prepared powders. 

Calomel and blue mass are largely used in the condition known as 
biliousness, and undoubtedly give relief. (See Biliousness.) If the 
tongue is heavily coated, the breath foul, the conjunctiva a little icte- 
roid, and headache is present, either of them should be employed. 
In remittent malarial fever the use of small repeated doses of calomel 
will often bring relief from the vomiting, and it should always be 
given in the treatment of malarial disease before quinine is used if a 
thorough action of the antiperiodic is required. 

The disinfectant and germicidal power of bichloride of mercury 
and of the biniodide is very well established by clinical experience 
and experimental investigation. The strength of the bichloride in 
solution for antiseptic purposes may vary from 1 to 2000 to 1 to 
20,000 of water, and for disinfectant use from 1 to 500 to 1 to 1000. 
(See Antiseptics.) 

In using the bichloride of mercury as an antiseptic it is necessary 
to add a few grains of tartaric acid to the solution to prevent its unit- 
ing with the albumin of the tissues to form an insoluble and useless 
albuminate. The same is true of the mercury biniodide. 

The antiphlogistic or anti-inflammatory action of mercury is very 
marked indeed, but its employment is absolutely limited under these 
circumstances to one variety of inflammation — namely, the sthenic or 
dynamic form. In inflammation arising during the course of some 
exhausting disease mercury is not only contraindicated, but harmful. 
Thus, if a man in health is stricken with pleurisy or peritonitis or 
meningitis or any acute inflammation of a serous membrane, be the 
cause what it may, the exudate poured out will probably be fibrinous, 
and capable of undergoing organization, thereby causing adhesions 
of the pleural surfaces, of the intestines, or of the meninges of the 
brain. On the other hand, if a man be taken with pleurisy or men- 
ingitis during the course of phthisis or typhoid fever, the exudate 
will be serous and large in quantity. It is in the first case that 
mercury should be used to prevent the fibrinous exudate or to make 
it serous. In the second instance it will do harm by increasing the 
exudation. 



250 DRUGS. 

When given as an antiphlogistic the drug is often combined with 
opium to relieve the pain and irritation and to prevent purging. In 
meningitis arising from head injuries this is the routine treatment, 
and may be carried out by the use of powders containing \ grain 
(0.015) of calomel and J grain (0.015) of powdered opium every hour 
till 1 or 1J grains (0.05-0.07) of each are taken. The simultaneous 
use of the ice-bag to the head and perfect quiet will often bring relief 
very rapidly. 

Mercury is also the best remedy in sthenic endocarditis, and should 
be given in full dose. The bichloride may be used in small doses in 
place of the calomel, and does not, of course, produce the same tend- 
ency to laxity of the bowels. At the same time, it often seems to be 
less efficacious. 

Mercury in myocarditis and pericarditis is also of service, and 
certainly exerts distinct prophylactic power in the early stages of 
diphtheria and membranous croup. (See Diphtheria.) 

Leaving the general subject of mercury, Ave may now consider 
each individual preparation. 

Ammoniated Mercury. 

White Precipitate, or Ammoniated Mercury (Hydrargyrum Ammo- 
niatum, U. S. and B. P.), is used in an ointment ( Unguentum Hydrar- 
gyri Ammoniati, U. S. and B. P.) in various skin affections. It 
should generally be diluted with lard. 

In ozcena, whether syphilitic or not, Trousseau has recommended 
the employment of the following powder as a snuff: 

R. — Hydrargyri ammoniati gr. iv (0.2). 

Pulv. sacchar. alb £ss (16.0).— M. 

S. — To be used as a snuff, after thoroughly blowing the nose. 

The red precipitate may be used instead of the white. This treat- 
ment removes the stench and may cure the complaint. It may, how- 
ever, irritate the mucous membrane, in which case it should be used 
in the strength of 2 grains to the J ounce (0.1 : 16.0). It is never 
used internally. 

Bichloride of Mercury. 

The Bichloride of Mercury, or Corrosive Sublimate (Hydrargyrum 
Qhloridum Corrosivum, U. S. ; Hydrargyri Perchloridum, B. P.) as 
it is called, is an exceedingly poisonous and irritating substance when 
taken in concentrated form. 

Taken internally, it causes violent pain in the stomach, vomiting, 
purging of mucus, blood, and the contents of the intestine, collapse, 
syncope, and death. If taken in poisonous amount, the patient should 
be made to swallow large amounts of the antidote, white of egg, the 
stomach should be washed out with the stomach-pump, heat should 
be applied about the body, and the proper stimulants be given if 
the pulse or respiration fail. If death does not occur at once, the 
patient generally has a protracted convalescence or else dies from the 



MERCURY. 251 

organic changes produced in the gastro-intestinal tract, such as stric- 
tures, sloughs, destruction of the peptic glands, and ulcerations. 

The bichloride of mercury is an exceedingly useful preparation 
of mercury for hypodermic injection in syphilis, and is better than 
calomel for this purpose. About -^ grain (0.012) may be injected 
deeply and gently into the cellular tissues every two or three days. 
When the injections are made the greatest possible cleanliness should 
be obtained. The needle should be aseptic and the hands of the 
operator well disinfected. The best place for the injection is in the 
gluteal region or between the shoulder-blades. 

Mercury bichloride, aside from its antiseptic use (see Antiseptics), 
is of great value when given internally, not only in syphilis, but in 
other states not associated with any such depraved condition, as in 
chronic Bright' s disease. In diphtheria it may be used to prevent 
fibrinous exudation as readily as calomel (see Diphtheria), and in ton- 
sillitis, where the inflammation is severe, it is often used with great 
service. 

When using a solution of bichloride of mercury as an antiseptic, 
tartaric acid should be added to the solution to prevent the precipita- 
tion of the mercury in the form of an albuminate. 

In small amounts — that is, in -^ to fa of a grain (0.0015-0.0017) 
three times a day — the bichloride is one of the best remedies which we 
possess for the treatment of anosmia, be its cause what it may. 

Bichloride of mercury is of value in minute doses of -g-J-Q to -fa of 
a grain (0.0003) in the ill-smelling green stools of summer diarrhoeas 
in adults and children, and it has been recommended that a solution 
be made of J a grain (0.03) in 5 ounces (160.0) of water, and a tea- 
spoonful given every hour until relief is obtained. The water used 
in making the solution should be distilled, and it may be well to add 
to it a little tartaric acid to prevent precipitation of the bichloride by 
organic matter which may have gotten into the water. This treat- 
ment is particularly useful in mucous diarrhoea in which blood and 
mucus are thoroughly mixed. Patients in the dispensaries often speak 
of these passages as containing " corruption," and others think they 
consist of "lumps of flesh," owing to the masses of blood and mucus. 
Whether the disease be acute or chronic, the bichloride, used in the 
way just described, will be found of service. In dysentery and the 
diarrhoea of adults the same treatment may be resorted to, using 2 
teaspoonfuls of the solution instead of 1. It is hardly necessary to add 
that the greatest care must be bestowed upon the diet and clothing. 
The author has treated a child suffering from persistent diarrhoea for 
months with varying success, only to succeed when, it being, found 
that the abdomen was exposed to the air, the mother was forced to 
apply and keep on the child a flannel binder. 

In some cases in which an obstinate syphiloderm is present J an 
ounce (16.0) of corrosive sublimate and 1 ounce (32.0) of chloride of 
ammonium may be added to a warm bath, which should be taken 
every few days. J a grain (0.03) of the bichloride of mercury in 6 
ounces (192.0) of water is said to be most efficient as an injection in 
gleet, if used every three or four hours. (See Gonorrhoea.) 



252 DRUGS. 

In all parasitic affections of the shin a solution of 2 grains (0,1) 
of bichloride to the ounce (32.0) of water may be sopped on the part 
three times a day. A solution of perchloride of mercury (Liquor 
Hydrargyri Perchloridi) is official in the B. P. : it is prepared by 
adding \ grain (0.03) of the perchloride of mercury to 1 ounce (32.0) 
of water, with \ grain (0.03) of ammonium chloride to hold it in solu- 
tion. (For the antiseptic uses of the bichloride of mercury see Anti- 
septics and Disinfectants.) 

Biniodide of Mercury. 

Mercury Biniodide (Hydrargyri Iodidum Rubrum, U. S. and B.P.) 
is a bright-red powder, possessing irritating powers equal to or above 
those of the bichloride, and causing symptoms, when taken in over- 
dose, closely resembling those produced by the latter drug. Owing 
to the formation of the salt, it is thought to be particularly useful in 
the later stages of syphilis. The dose is -g 1 ^- to y 1 ^- of a grain (0.003- 
0.006). (See Syphilis.) An ointment (Unguentum Hydrargyri Iodidi 
Rubri, B. P.) is useful as an application in goitre and obstinate skin 
diseases. 

At one time it was thought that biniodide of mercury was a better 
antiseptic than the bichloride, but recent researches have proved that 
this is not a fact. 

Black Wash. 

Black Wash (Lotio Hydrargyri Nigra, B. P.) is made by adding 
1 drachm of calomel to a pint (4.0 : J litre) of lime-water. It is used 
for washing syphilitic sores and ivounds and in various forms of eczema. 

Blue Mass. 

Blue Mass (Massa Hydrargyri, U. S. ; Pilula Hydrargyri, B. P.) 
is made by rubbing up metallic mercury with liquorice and other 
excipients, and is often called Blue Pill. Each grain of the mass 
contains J grain (0.02) of mercury, and it may be given in the dose 
of from J to 20 grains (0.03-1.3) for the same laxative purposes for 
which we use calomel. Blue mass is rarely used to produce systemic 
effects. 

Calomel. 

Calomel (Hydrargyri Chloridum Mite, U. S. ; Hydrargyri Subchlo- 
ridum, B. P.\ ox the Mild Chloride of Mercury, is an insoluble salt 
which is, nevertheless, freely absorbed. 

Calomel when used as a iaxative purge should be given in the dose 
of \ to | grain (0.01-0.03) every half-hour or every fifteen minutes until 
1 or 2 grains (0.05-0.1) are taken, as it will act as efficiently in this 
way as if 10 grains (0.65) are given at one dose, and there is no dan- 
ger of producing ptyalism. The reason that small doses are as efficient 
as large ones lies in the fact that only the calomel which is changed 
into the gray oxide is active, and, as the amount of alkaline juice in 



MERCURY. 253 

the intestine is small, only a minor part of a large dose of calomel 
acts, the major portion escaping unchanged. This is the reason that 
bicarbonate of sodium is added to calomel powders, to aid the intes- 
tinal juice in the reduction of the salt. If purgation does not occur 
after a dose of calomel, a saline purge may be given at the end of 
twenty-four hours, and this must always be used if large doses of the 
mercurial are employed, to avoid possible mercurialization. 

Mercury in the form of calomel is very largely used hypodermic- 
ally, being held in solution by a mucilage, or, better still, by fluid 
cosmoline. Best of all, however, is the employment of chloride of 
sodium in water with the calomel, in the proportion of 5 parts each 
to 50 parts of water. It should be injected deeply into the tissues, 
not immediately underneath the skin, the greatest cleanliness being 
necessary to avoid abscesses. The best place for these injections is 
in the fold of the buttocks, but sloughing, tetanus, and even gan- 
grene, has followed its employment in this way. (See also Salicylate 
of Mercury and Bichloride of Mercury.) 

In dysentery of the acute form calomel and ipecac are the two 
best remedies. (See Dysentery and Ipecac.) The calomel should be 
given in small doses, repeated every hour or half-hour until a favor- 
able change in the number and character of the stools appears. Cal- 
omel is not to be used if great asthenia complicates the disease. 

In children who seem constantly u under the weather" and never 
quite well, who have flatulence, foetid breath, and ill-smelling, pasty 
stools, calomel often gives great relief in the dose of -^ of a grain 
(0.003) every half-hour until four doses are taken, this treatment 
being pursued every fourth or fifth morning. 

In jaundice due to exposure to cold and to slight hepatic conges- 
tion \ of a grain (0.01) of calomel every half-hour until \ grain 
(0.03) is taken will often bring relief. 

Calomel is generally prescribed in conjunction with sugar of milk, 
white sugar, or bicarbonate of sodium, which are added to increase 
the bulk and wieldiness of the powder, and, in the case of the latter 
ingredient, to increase its activity. Owing to its lack of taste, calo- 
mel is often placed on the tongue in children, but in this instance 
white sugar is to be used in small quantity, as the other vehicles are 
less agreeable. The most agreeable form of administration is in 
triturates. 

It is important to remember that calomel, when used as an anti- 
syphilitic, produces salivation very much earlier than the other mer- 
curials. 

Sometimes calomel is of value when dusted into the eye in cases 
of phlyctenular conjunctivitis which are strumous. This practice 
must not be resorted to if iodine or iodides are being taken inter- 
nally, as the iodine is eliminated by the tears and forms a compound 
which burns the conjunctiva. 

A very important use of calomel, and one which has been brought 
forward very recently as new, but which is really many years old, is 
its employment in dropsy as a diuretic, either alone or combined with 
squills or digitalis, or with opium to prevent purging. The dose is 



254 DRVGS. 

small, about 1 grain (0.05) thrice a day, and if a diuretic influence 
does not assert itself in forty-eight hours it should not be continued. 
How calomel acts to produce the increased urinary flow under these 
circumstances we do not know. Some suppose that it aids the absorp- 
tion of liquid from dropsical tissues, and so increases urinary secre- 
tion ; others think that it stimulates the renal epithelium to greater 
activity. The latter seems the least probable of the two, but neither 
theory has been proved correct, although experimentation supports 
the view first named. The full urinary effect of the drug is not felt 
till the second or third day of its use, and speedily passes away, par- 
ticularly as purging is often induced very early. Still another use 
of calomel is in typhoid fever, in which disease it has been highly 
recommended in small repeated doses, particularly if constipation is 
present. In the opinion of the author this is disadvantageous as a 
routine measure and entirely uncalled for, although in the very early 
stages of the disease, when the bowels are confined and the tongue 
coated, a dose of 1 grain (0.05) in fourths with a little bicarbonate 
of sodium is useful. 

Sydney Ringer has called attention to the fact that in constipa- 
tion or in "biliousness" podophyllin does more good than calomel, 
provided that the stools are dark in color, whereas if the same signs 
are present, but the stools light and clayey in color, calomel is more 
efficient. The author has proved the correctness of this assertion so 
frequently that he is convinced of its truth. 

Calomel has been recommended in the condition of anorexia and 
depression following acute diseases, and when the tongue is covered 
by a thick yellow coat it is the remedy for the gastro-intestinal tor- 
por always present. While purgative doses of calomel certainly are 
of value, the use of freshly-prepared nitro-muriatic acid is, however, 
highly preferable to the mercurial salt in many such instances. 

Calomel is often given in small doses to "settle the stomach." 
Sometimes it will act in this way, but in other cases it will seem to 
increase the nausea and bring on vomiting. This is true of both 
adults and children, and it is impossible to tell beforehand which will 
occur. Ringer asserts that in a peculiar form of vomiting occurring 
in very young children, which comes on immediately after the food is 
swallowed, the rejection of milk being forcible, and perhaps so sudden 
that it is not even curdled, and which is not accompanied by much 
straining, calomel will often give relief when all other remedies fail. 
It should not be resorted to until some evidences of wasting occur, as 
this action of the stomach in many children only rids that organ of 
that part of the milk which is in excess, and is a purely physiological 
regurgitation. The calomel may be given in the dose of -^ of a 
grain (0.005) every hour, or, if preferred, gray powder in the dose 
of -J- of a grain (0.02) every hour for three doses is equally efficient 
in these cases. 

Calomel will often remove syphilitic condylomata if dusted over 
them for some time, and an ointment made of 1 drachm (4.0) of cal- 
omel to 1 ounce (32.0) of lard is very useful in pruritus. 

Calomel ointment ( Unguentum Hydrargyri Subehloridi, B. P.) is 



MERCURY. 255 

often useful in the treatment of small patches of eczema, or the fol- 
lowing prescription may be given for its use : 

R. — Hydrarg. clilor. mit gr. xl (2.65). 

Magnesia? carbonatis gr. xl (2.65). 

Unguent, aqua? rosse ,§j (30.0). — M. 

Gray Oil. 

Gray Oil is prepared as follows: 2 drachms (8.0) of lanolin is 
rubbed up with enough chloroform to emulsify it. The rubbing 
process is continued until most of the chloroform is evaporated, and 
while the mixture is still in a fluid state metallic mercury in double 
the amount of lanolin, 4 drachms (16.0) is added and the tritu- 
ration continued. By this means an ointment of mercury is left 
which equals 2 parts of mercury and 1 of lanolin. This is some- 
times called Strong Gray Ointment. For hypodermic injection 3 
parts of this gray ointment are added to 1 part of olive oil, or it may 
be still further diluted by adding olive oil in the proportion of half- 
and-half. Of this mixture 1 to 2 minims (0.05-0.1) may be injected 
every second or third day. 

With some practitioners this preparation is considered much the 
better for hypodermic use in syphilis. 

Mercury with Chalk. 

Mercury with Chalk (Hydrargyrum cum Creta, JJ. S. and B. P.), 
or Gray Powder, is slightly purgative, but is chiefly employed in the 
treatment of infantile syphilis, as it will not freely purge. It is com- 
posed of 38 parts of mercury, 12 parts of sugar of milk, and 50 parts 
of prepared chalk. The dose is 1 to 10 grains (0.06-0.65). Chil- 
dren suffering from syphilitic marasmus seem fairly to fatten on it. 
This preparation is also of service in adults, and may be employed 
whenever the laxative effect of mercury is not desired. 

In the treatment of infantile diarrhoea with watery, colorless 
stools containing undigested food gray powder in small doses is often 
very useful. 

Mercury Ointment. 

The Ointment of Mercury, Mercurial Ointment (Unguentum 
Hydrargyria U. S. and B. P.), sometimes called Blue Ointment, is 
made by rubbing up mercury with suet and lard until it is extin- 
guished, or, in other words, until the globules of mercury cannot be 
seen with a magnifying power of ten diameters. 

The ointment of mercury is used externally in certain skin affec- 
tions and for the purpose of influencing the general system in cases 
where the drug cannot well be taken by the mouth. In syphilis where 
a mercurial effect is to be reached the ointment in small amounts 
should be thoroughly rubbed into the skin in various parts of the 
body — one evening in the left groin, the next in the right groin, the 
next evening in the left axilla, and the fourth evening in the right 



256 DR UOS. 

axilla, beginning on the fifth evening in the left groin once more. 
This avoids local irritation of the skin by means of too frequent 
applications, places the drug on spots where it is readily absorbed, 
and very rapidly influences the system of the patient. In infantile 
syphilis this method may be employed, or a flannel binder covered 
with the ointment may be placed about the belly. The clothes should 
not be changed too frequently, as their saturation with the drug aids 
in producing the impression upon the system, and the wearing of an 
undershirt saturated with the ointment after a few days' wear is a 
very valuable, though somewhat dirty, method of producing mercu- 
rialization. The ointment of mercury is sometimes rubbed into the 
skin over enlarged glands. Under the name of Oleate of Mercury 
(Oleatum Hydrargyria U. S. and B. P.) a very efficient and more 
agreeable application than the ointment is used in the same manner 
or still further diluted with lard. It is made from the yellow oxide 
of mercury. (See Oxides of Mercury.) 

For pediculus pubis, or in any case where parasites, such as the 
flea or louse, infest the region of the genitals or any spot covered by 
a hairy growth, mercurial ointment may be used as a remedy, owing 
to its lethal influence over these troublesome pests. Care should be 
taken that it does not cause salivation of the patient, and it must not 
be allowed to remain on the parts, but be wiped off in the course of 
an hour or two or less. The following words from the pen of Dr. 
Joseph Leidy are sufficiently interesting to demand a place at this 
juncture: "We may here say that if it is once understood that all 
insects, including lice, are destroyed quickly by the application of 
any fixed or volatile oil, physicians will see there is no necessity of 
employing remedies of a noxious character to the patient. The fat 
of mercurial ointment is probably more active than the mercurial 
oxide." 

Mercurial suppositories (Suppositoria Hydrargyria P. B.) are used 
when a mercurial effect is desired without the danger of interfering 
with the digestion. 

Linimentum Hydrargyria B. P., and Hmplastrum Hydrargyria 
TJ. S. and B. P., are used for the same purposes as is the ointment 
of mercury. The plaster is made with olive oil, resin, and lead plas- 
ter instead of ordinary suet or lard. 

Nitrate of Mercury. 

The Solution of Mercuric Nitrate {Liquor Hydrargyri Nitratis, 
TJ. S. and B. P.), Acid Nitrate of Mercury, is an exceedingly active, 
penetrating caustic, so rapid in its effects that it seems to drop through 
the tissues. It may be employed for the removal of epitheliomata and 
large warts, and should be applied by means of a glass rod. This 
treatment may also be resorted to with advantage in lupus until the 
surface of the growth is level with the skin. The surrounding parts 
should be protected by lard or oil. 

As this treatment is very painful, the spot should afterward be 
covered with flexible collodion. 



MERCURY. 257 

Citrine Ointment (Unguentum Hydrargyri Nitratis, U. S. and 
B. P.) is used in chronic shin diseases of the scalp and trunk. It 
is too strong for ordinary use, and should be diluted one-half or 
less with lard according to the stimulating effect required ; the dilute 
ointment is official in the B. P. as Unguentum Hydrargyri Nitratis 
Dilution. 

Oxides of Mercury, 

The Yellow and Red Oxide of Mercury {Hydrargyri Oxidurn 
Flavum, U. S. and B. P.) and Hydrargyri Oxidum Mubrum, U. S. 
and B. P., Red Precipitate, are used largely as a dressing for syph- 
ilitic sores when diluted about one-half with chalk or other powder. 
If used pure, they are somewhat caustic. From the yellow oxide is 
made the Oleate of Mercury (Oleatum Hydrargyria U. S. and B. P.), 
which is used for the same purpose as ordinary mercurial ointment. 

In intestinal and gastric indigestion, with foul belching and very 
ill-smelling stools which are due to intestinal sepsis, the yellow oxide 
is sometimes given in the dose of -^ to -^ of a grain (0.001-0.0012) 
in trituration. 

Red Precipitate Ointment {Unguentum Hydrargyri Oxidi Rubri, 
U. S. and B. P.) and the Ointment of the Yellow Oxide (Unguentum 
Hydrargyri Oxidi Flava, U. S.) are largely used, diluted one-half 
with lard, in chronic scaly skin affections, in obstinate conjunctivitis, 
and in granular lids. (See Styes.) They should always be freshly 
prepared. 

Protiodide of Mercury. 

Mercury Protiodide (Hydrargyri Iodidum Flavum, U. S.) is 
much more mild than the biniodide, and is given for exactly the 
same purposes. It is very useful in chronic Bright's disease. It is 
to be remembered as the best mercurial preparation for ordinary cases 
of syphilis. The dose is jr to | of a grain (0.01-0.016) three times a 
day. 

Yellow Sulphate of Mercury. 

Hydrargyri Subsulphas Flavus, U. S., has been used under the 
name of Turpeth Mineral as an errhine in chronic ophthalmia and 
also as a prompt emetic in croup. It is a quick and certain emetic, 
and, it is claimed, does not produce depression, but the writer would 
recommend great care in its use. The dose for a two-year-old child 
is 2 to 5 grains (0.1-0.35), repeated in fifteen minutes if necessary. 

If as much as 5 grains (0.35) has been given, and emesis does 
not follow, other emetics or the stomach-pump must be used to pre- 
vent gastro-intestinal irritation. 

Yellow "Wash. 

Yellow Wash (Lotto Hydrargyri Flava, B. P.) is made by adding 
30 grains (2.0) of corrosive sublimate to a pint (^ litre) of lime-water. 
It is used for the same purposes as the black wash, but is much more 
stimulating. 
17 



258 DRUGS. 

Incompatibles. — Bichloride of mercury should never be given with 
any other substance except iodide of potassium and chloride of ammo- 
nium, as it is incompatible with almost every other drug. With the 
iodide of potassium it may be used, because the precipitate formed is 
at once redissolved and the resulting mixture is highly alterative. 

Calomel should never be given with iodides or bromides, and hydro- 
chloric acid may convert it into the bichloride if the acid is present 
in any amount. 

One of the best ways to employ any of the various forms of mercury 
is in the form of triturates, which may be prepared by triturating 10 
parts of the drug with 90 parts of milk-sugar. The minute subdi- 
vision of the medicament aids in its efficiency, because of its more 
ready absorption. 



METHYL BLUE. 

Methyl Blue or Methyl Violet is an aniline dye often sold under 
the name of Pyoktanin. When used medicinally, it must be perfectly 
pure and deprived of its contaminating matter, arsenic, which if pres- 
ent causes local irritation of the part to which ic is applied. Pyok- 
tanin was introduced to professional notice under this name by Still- 
ing as an antiseptic, but careful study has proved it to be of very 
feeble power over the growth of germs. In all conditions of the eye 
in which antiseptic lotions are indicated pyoktanin has been stated to 
be of value, but elsewhere in surgery it is practically useless as an 
antiseptic. Even in the eye it possesses, according to De Schweinitz, 
a very limited range of usefulness, being no better than the older 
antiseptics, except in diseases of the lachrymal apparatus. The fact 
that pyoktanin stains everything it touches is a great disadvantage in 
its use. It may be tried in blepharitis, eczema of the eyelids, con- 
junctivitis, both simple and phlyctenular, and in the treatment of 
corneal ulcer. When so employed it should be applied in the strength 
of 1 to 1000 of water. 

It should be remembered that any pure aniline dye may be used 
in place of pyoktanin. Thus we have yellow pyoktanin or auranine. 

Methyl blue and similar aniline substances are widely employed by 
some persons in the treatment of malignant neoplasms. The solution 
(1 to 500 of water) should be filtered through hot asbestos to render it 
sterile, and every antiseptic precaution carefully adhered to in giving 
the injection. The dose is \ to 3 drachms (2.0-12.0) of this solution 
every other day or every third day, and the injection is to be given 
either into the growth itself if it is large, or just at the side, in the 
healthy tissues, if it is small. Too much should not be injected into 
one spot, lest it cause a slough. This treatment does not cure the 
disease. It relieves pain and quiets the patient, and in rare cases 
stops the growth of the tumor. If the growth sloughs, complete anti- 
septic dressing is necessary. An antiseptic pyoktanin-gauze dressing 
should always be used while the treatment is going on. 



METHYLENE BLUE. 259 



METHYL CHLORIDE. 

Methyl Chloride is a colorless gas, easily liquefied under pressure, 
with an odor resembling that of ether and chloroform, used to produce 
local anaesthesia, which it does by absorbing a large amount of heat 
on passing from the liquid to the volatile state as it strikes the skin. 
It is usually kept in a small flask which has its end fused into a fine 
point. This is broken off, and the heat of the hand volatilizes the 
drug, which is then forced out of the flask in a fine spray. The 
nozzle should be held ten to twelve inches from the part to be frozen. 
The skin of the part to be anaesthetized should be washed with soap 
and ether to remove all fatty substances before the spray is used. 

Under these circumstances the skin becomes pale in a few seconds, 
and afterward perfectly white and parchment-like in appearance. 
Local anaesthesia is now complete, and minor surgical operations, 
such as opening boils or abscesses, can be performed without pain. 
The spray should not be continued more than two to four minutes, as 
local death of the tissues may result. A great advantage of the spray 
of methyl over that of ether is its slight inflammability and rapidity 
of action. Methyl chloride is to be distinctly separated from methyl- 
ene chloride. The first is monochlormethane, the second dichlorme- 
thane. 

METHYLENE BLUE. 

Methylene Blue is to be definitely separated in the mind of the 
student from methyl blue, which is practically what is known by the 
trade-name " Pyoktanin." 

It has been employed in the treatment of malignant growths and 
in malarial fevers with asserted success, although its use in the first 
group of cases is decidedly problematical. When used in the treat- 
ment of sarcoma and cancer, from -| to 2 grains (0.03-0.12) in watery 
solution are injected directly into the growth. The neoplasm, it is 
said, ceases to grow, shrinks, and comes away, leaving a fairly 
healthy sloughing surface. This treatment is so uncertain that it 
should only be tried in inoperable cases. 

In malarial fever of the intermittent type methylene blue seems 
to possess very distinct curative powers, if we can rely on the studies 
of Thayer, Kasembeck, Mya, and others. It is not so powerful as 
quinine by any means, but has its chief sphere of usefulness in patients 
who cannot take quinine or where quinine has been tried unsuccess- 
fully. This antimalarial influence is due to its destruction of the 
Plasmodium malaria?, but it must be continued after the attacks have 
ceased and for some little time after the physician fails to find the 
micro-organism, as relapses are common. 

Untoward symptoms from its use are not common, but when they 
do occur consist in slight vertigo, nausea, and some strangury. The 
urine is always blue from the elimination of the drug through the 
kidneys. Particularly good results seem to follow the use of methyl- 
ene blue in children suffering from malaria. The dose is 2 to 4 



260 DRUGS. 

grains (0.1-0.2) every four hours to adults, or 1 to 2 grains (0.05-0.1) 
to children of five years, preferably given in capsule. 



METHYLENE CHLORIDE. 

Methylene Chloride is made from chloroform or by the action of 
chlorine on marsh-gas, and is a colorless liquid resembling chloroform 
in odor. It is readily decomposed by light, which process may be 
hindered by the addition of a little absolute alcohol. 

Therapeutics. — It is employed as an anaesthetic in a manner like 
chloroform, and was introduced as a safe substitute for that drug, but 
it is of doubtful safety and is little used. It has been used as a spray 
for the production of local anaesthesia. As stated under Methyl 
Chloride, it is not to be confounded with that drug. In England, 
under the name of methylene chloride or methylene, a mixture of 
ethyl ether and methylene chloride has been widely employed. This 
preparation is, of course, to be distinguished from true methylene 
chloride. The amount of this mixture used to produce anaesthesia is 
1 to 2 drachms (4.0-8.0) for minor and 3 to 6 drachms (12.0-24.0) 
for major operations. The term " methylene chloride " has also been 
applied to a mixture of chloroform and methyl chloride. 



MEZEREUM. 

Mezereum, U. 8. {Mezerei Cortex, B. P.), is the bark of Daphne 
Mezereum, a plant of Asia, Europe, and Great Britain. It is sup- 
posed by some to be possessed of extraordinary alterative power, but 
this is certainly a mistake, as its influence in this line is very feeble. 
It is never used internally except in compound decoction of sarsa- 
parilla. It is distinctly irritant, and in overdose causes all the symp- 
toms of gastro-enteritis. Mezereum is so irritant as to have been 
used externally as a counter-irritant in the form of the ointment 
(JJnguentum Mezerei). It enters into the compound syrup, fluid 
extract, and decoction of sarsaparilla. The official preparations of 
mezereum are the fluid extract (Pxtr actum Mezerei Fluidum, TJ. S.) 
and the ethereal extract (Extractum Mezerei JEthereum, B. P.), both 
of which are used as external irritants. 



MUSK. 

Musk (Moschus, U. S. and B. P.) is obtained from the preputial 
follicles of the musk deer of Thibet, and is a substance possessing 
the most remarkable penetrating powers so far as odor is concerned. 
Very little of the musk for sale in the shops is pure, and most of it 
is not musk at all. Its price varies very greatly, but if sold for less 
than twenty-five cents a grain it is probably worthless or impure. 

Therapeutics. — For some unknown reason musk acts as a diffusible 



MUSTARD. 261 

stimulant and supports the system. It is also an antispasmodic and 
nervous sedative. In all low fevers where the strength of the patient 
is fast ebbing aAvay and the nervous symptoms are those of the most 
advanced depression, rectal injections of musk in starch-water should 
be employed. The dose should be 5 to 10 grains (0.35-0.65). This 
drug is of value where either nervous excitement or nervous collapse 
is present, but is not to be employed until it is absolutely needed to 
carry the patient past a crisis. If frequently employed, it loses its 
power and the expense is a needless one. 

Musk is one of the best remedies in obstinate hiccough. The dose 
of the tincture (Tinctura Moschi, U. S.) is 30 drops to 1 drachm 
(2.0-4.0), and of musk itself 5 to 10 grains (0.35-0.65). 



MUSTARD. 

Mustard is official in the form of Sinapis Alba, TJ. S., and Sin- 
apis Albce Semina, B. P., or white mustard, and Sinapis Nigra, 
TJ. S., and Sinapis Nigra? Semina, B. P., or black mustard. Both 
of these contain an irritant oil {Oleum Sinapis Volatile, TJ. S. ; 
Oleum Sinapis, B. P.) as their chief active constituent. 

Therapeutics. — Mustard is often used in the form of mustard flour 
as an emetic when stirred up in water in the proportion of a table- 
spoonful to a glass of water. It is also employed as a counter-irritant 
and as a condiment. If given in excessive dose, it will cause violent 
gastritis, and chronic gastritis is often set up by its constant use. It 
is contraindicated internally during the existence of acute gastritis 
and all similar states. 

When used as a counter-irritant mustard is applied to relieve the 
pain of colic due to flatulence and acute inflammation, in muscular rheu- 
matism and inflamed joints, and for neuralgia, and it may be applied 
at the nape of the neck in cases of headache and cerebral congestion. 
When applied to the skin of an ordinary individual, it will produce 
a bad burn if left on more than a few minutes, and it should be mixed 
with wheat flour in the proportion of half-and-half for tender skins. 
Children generally will not stand more than one-fourth mustard. The 
plaster should be made with warm water or vinegar, or a little brandy 
may be used. Mustard plaster (Cataplasma Sinapis) is official in 
the B. P. 

The scald or burn produced by mustard is peculiar in its slowness 
to heal, and in the fact that it is tender and reddened for da} 7 s. If 
the burning of the mustard becomes excessive, it should be treated by 
a piece of lint soaked in lime-water and olive oil, half-and-half, or 
olive oil alone may be used. 

The oil of mustard is very irritant, and almost epispastic in its 
effects. It is given in the treatment of the atonic stomach of drunk- 
ards in the dose of J to \ a drop (0.016-0.03). Charta Sinajns, 
TJ. S. and B. P., or mustard-papers, are sometimes called sinapisma, 
and these afford a ready means of applying this counter-irritant. 
They are generally very strong, and should be covered by one or two 



262 DRUGS. 

layers of old and moistened linen to prevent too great an action. (See 
Counter-irritation.) The compound liniment (Linimentum Sinapis 
Oompositum, U. S. and B. P.) is composed of the oil of mustard, 
castor oil, extract of mezereum, and alcohol. 



MYRRH. 

Myrrha, U. S. and B. P., is a gum-resin obtained from Com- 
miphora Myrrha, a tree of Arabia. It occurs in dark-colored tears, 
and contains an active principle, myrrhin. 

Therapeutics. — Myrrh, in medicinal amount, is a stimulant to the 
circulation and to the uterine and the bronchial mucous membranes. 

In amenorrhoea due to functional inactivity, or ancemia, " iron and 
myrrh " is a standard remedy. 

The tincture of myrrh, diluted one-half, is useful in ulcerated sore 
throat as a gargle, and the pure tincture is sometimes applied with a 
small brush or by the end of the finger to spongy or tender gums. 

In leucorrhoea depending upon uterine trouble and in chronic 
cystitis myrrh is often of service. Sometimes it enters into expec- 
torant mixtures given in the later stages of bronchitis. The dose of 
the tincture (Tinctura Myrrhce, U. S. and B. P.) is 10 to 30 drops 
(0.65-2.0). It also enters into the composition of Pilulce Aloes et 
Myrrhce, U. S. and B. P., dose two to five pills, and Tinctura Aloes 
et Myrrhce, U. S. and B. P., the dose of which is 1 to 2 fluidrachms 
(4.0-8.0). 

NAPHTHALIN, or NAPHTALENE. 

Naphthalinum, U. S., is a coal-tar derivative occurring in color- 
less mica-like crystals, possessing a peculiar smell, and soluble in 
alcohol to some slight extent. Helbing states that naphthalin when 
pure is colorless and without action on moist litmus-paper. It should 
also dissolve in concentrated sulphuric acid without color when gently 
warmed. After it is taken for some time, or even after the first dose, 
the patient will state that when he belches the gas has the smell and 
taste of burning rubber. 

The drug possesses distinct antiseptic power, and for this reason 
has been employed in certain gastric and intestinal diseases asso- 
ciated with fermentative changes or dependent upon ulceration and 
organic lesions. In foetid diarrhoea it may be given as a deodorant 
and cure. 

When given to children, as in summer diarrhoea, the dose should 
be \ to I grain (0.01-0.015) every two or four hours, but adults may 
take as much as 5 to 10 grains (0.35-0.65). More than this will dis- 
order the stomach. The drug should be given in powder, in capsule, 
or with sugar. It has not been as widely employed as was expected 
when it first came before the profession, and certainly often fails to 
do good. 

In cats and rabbits naphthalin, when administered continuously for 
a considerable period of time, produces cataract. 



NITRATE OF SILVER. 263 



NAPHTOL. 

Naphtol (U. S.), often called Beta-naphtol, has been introduced 
in the TJ. S. P. of 1890. It is used for precisely the same purposes 
as naphthalin internally, and is generally artificially prepared from 
naphtalin. It is also used in antiseptic dressings. The dose is 2 to 
5 grains (0.15-0.3). 



NITRATE OP POTASSIUM. 

Nitre (Potassii Nttras, TJ. S. and B. P.), or Saltpetre, occurs in 
long needle-like crystals and has a sharp, saline taste. Sal prunella 
is saltpetre melted and run into moulds. 

Next to the chlorate of potassium, this is the most poisonous of the 
potassium salts, and produces when taken in overdose symptoms of 
violent gastro-enteritis. While it does not affect the blood, it is more 
irritant than the chlorate. 

Nitrate of potassium is rarely employed at present, and has been 
very properly put aside as inferior to the harmless vegetable potas- 
sium salts (the citrate, acetate, and bitartrate). If used in rheuma- 
tism, the dose should be 1 ounce (32.0) in i pint (J litre) of barley- 
water or syrup of acacia and water, to be taken in divided doses of a 
tablespoonful every three hours. Nitrate-of-potassium papers (Charta 
Potassii Nitratis, TJ. S.) are made by dipping unsized paper in a 
solution of the drug of the strength of 20 parts of the salt to 80 
parts of distilled water. They are rolled into cigarettes and smoked 
by asthmatics, or burned in a pan and the fumes arising from them 
inhaled. Their efficacy may be increased in cases where the respira- 
tory mucous membrane is irritable by dipping them in compound 
tincture of benzoin and exposing to the air long enough to dry. 
They should then be protected from the air until used. 
The paper should be medium thin bibulous paper. 



NITRATE OP SILVER. 

Nitrate of Silver (Argenti Nitras, TJ. S. and B. P.) is a heavy, 
crystalline salt of silver readily soluble in its own weight of water. 

It is official as the pure nitrate {Argenti JSfitras, TJ. S. and B. P.) 
and as the sticks or fused rolls (Argenti Mtr as Fusus, TJ. S.), or lunar 
caustic. The latter are never used in medicine internally, only the 
crystals being employed. Applied to the tissues of the body or other 
substances, it causes a brown and finally a black stain, which is due 
to the formation of an oxide of silver. 

Physiological Action. — Nitrate of silver is one of the feAV astrin- 
gent substances which are applicable to inflamed mucous membranes, 
as it is, with lead, bismuth, and zinc, one of the few drugs of the 
class which is not irritant as well as astringent. Locally applied, it 
acts in pure form as a powerful caustic, which is, however, very 



264 DRUGS. 

superficial indeed, as the drug coagulates the albumin with Avhich it 
comes in contact and thereby forms a coat which protects the tissues 
beneath. 

The action of the drug upon the circulation, respiration, and sim- 
ilar vital functions is only partly known, and has no relation to its 
employment in medicine. 

Nitrate of silver is eliminated from the system very slowly indeed. 

Poisoning. — Almost immediately after the ingestion of a poisonous 
dose of nitrate of silver violent pain in the belly, with vomiting and 
purging, comes on. At the same time evidences of widespread gas- 
troenteritis develop. The abdominal walls are knotted and hard, 
and perhaps scaphoid. The face is anxious and livid and covered 
with a sweat. When the vomiting occurs the ejecta are seen to be 
brown or blackish, or even white and curdy. The lips are stained 
white, then brown, then black. In some cases the nervous symptoms 
are severe and convulsions with delirium may occur. The convulsions 
are epileptiform. Death ensues either from gastro-enteritis or from 
centric respiratory failure, accompanied by a profuse exudation of 
liquid mucus into the bronchial tubes. 

The treatment consists in the use of common salt, which is the 
chemical antidote, the employment of opium and oils to allay irrita- 
tion, and in the ingestion of large draughts of milk and of soap and 
water for the purpose of diluting the poison and protecting the mucous 
membranes of the oesophagus and stomach from the action of the irri- 
tant. The bodily heat must be maintained. 

Chronic Poisoning. — This is a form of poisoning quite frequently 
seen. The most prominent symptom is the pale slate-blue color of 
the skin, which causes the individual to be most livid and death-like 
in appearance. 

Argyria, as chronic silver poisoning is called, is caused by the 
continued employment of the drug until it is deposited in the tissues. 
It is then found in every part of the body. The first signs of dis- 
coloration can generally be seen in a darkening of the conjunctiva 
over the sclerotic coat of the eye or in a dark line on the inner part 
of the lips. 

The treatment of argyria is not hopeful so far as the color of the 
skin is concerned, but it may be improved by the use of iodide of 
potassium to aid in the elimination of the poison. 

Therapeutics. — Internally, this salt is used as a cure for gastric 
ulcer, and it is certainly the best remedy we possess if combined with 
extract of hyoscyamus or opium in pill form. In chronic gastric 
catarrh and gastritis nitrate of silver is very useful Avhen the patient 
is troubled with sour eructations or when vomiting occurs after meals. 
When used in these states it should be given in -j- to J-grain (0.01- 
0.16) doses, half to one hour before each meal, in order that the 
stomach may be exposed to its effects and not be protected by food. 

In intestinal ulceration the drug has been highly recommended by 
Dr. Pepper, and under these circumstances should be given in hard 
or keratin-coated pills, in order that it may escape through the stom- 
ach without being chemically changed. In ulceration of the cwcum 



NITRATE OF SILVER. 265 

and rectum and in acute and chronic dysentery the disease should be 
attacked by rectal or colon injections of nitrate of silver. If the 
caecum is involved, the solution must be in large quantity in order to 
reach the part affected, but if the rectum is diseased, the amount of 
liquid injected should not exceed 4 ounces, the bowel in either case 
being washed out beforehand by warm water to rid it of faeces. Soap 
and water and salt and water must not be used for this purpose, as 
the soap which remains in the bowel will prevent the silver salt from 
acting. The strength of the solution employed should be 1 drachm 
to 3 pints (4.0 : 1500 cc.) of water in caecal trouble, and 3 grains 
(0.18) to each 4 ounces (128.0) in rectal trouble. If the latter con- 
dition is very obstinate and chronic, the strength may be raised to 5 
grains (0.3) to each 4 ounces (128.0). 

Whenever nitrate-of-silver injections are used in this way, a solu- 
tion of salt and water should be made, ready for use, and injected if 
the action is too severe or as soon as it is thought that the drug has 
acted with sufficient thoroughness. 

Nitrate of silver is the only remedy of any value in idiopathic 
anterior and posterior spinal sclerosis, but often fails. 

Nitrate of silver has been largely used in epilepsy and chorea, but 
is now seldom so employed, and does little good in most cases. 

Dr. William Pepper speaks highly of the continual administration 
of nitrate of silver in pill form in the dose of \ to \ grain (0.01- 
0.015) through the entire attack of typhoid fever, and believes it 
greatly modifies the severity of the disease. 

Externally, nitrate of silver is used for many purposes, and will 
often prevent the pitting of small-pox if on the fourth or fifth day the 
vesicles are punctured by a needle dipped in a solution of nitrate 
of silver in the strength of 20 grains (1.3) to the ounce (32.0) of 
water. Others simply paint the skin over the eruption with a 
solution of 5 to 10 grains (0.35-0.65) to the ounce, claiming that 
this method is equally effective and prevents inflammation and sup- 
puration. 

Higginbottom has highly recommended the use of nitrate of silver 
over erysipelatous inflammations, but the practice is not often resorted 
to, and is now supplanted by better measures. (See Erysipelas.) In 
other inflammations of a superficial character nitrate of silver is of 
great value. Painted in strong solution over the scrotum in the early 
stages of orchitis or epididymitis, it will often relieve the pain and 
swelling, and felons can sometimes be aborted by its early application 
over the surface of the finger. 

In all inflammations of the pharynx, larynx, fauces, and mouth 
solutions of silver nitrate are to be used in varying strength. Some- 
times after slight exposure to cold or dampness the posterior wall of 
the pharynx suddenly becomes sore and raw, feeling as if the mucous 
membrane had been scarified. A solution of nitrate of silver will 
relieve this, and if it is employed in the strength of 60 grains (4.0) 
to the ounce (32.0) of water, the application will be more efficacious 
and less painful than if weaker solutions are employed. 

In laryngeal phthisis a spray used from an atomizer in the strength 



266 DRUGS. 

of J to 2 grains (0.03-0.1) to the ounce (32.0) of water may do good 
service. 

In tuhooping cough Ringer recommends the use of a spray in the 
strength given above for the purpose of relieving the cough in its vio- 
lence and frequency and of obtaining a good night's rest. The appli- 
cations should be made when the stomach is empty, as they are apt to 
bring on retching. The end of the atomizer must be within the 
mouth or the skin of the face will be stained. 

In the later subacute stages of gonorrhoea an injection of nitrate 
of silver of the strength of 2 to 4 grains (0.1-0.25) to the ounce 
(32.0) is very useful. 

In uterine ulceration and in leucorrhoea when the cervix is boggy 
and tender, the application of the solid nitrate-of-silver stick is of 
service. Its use is often followed by headache about the vertex, and 
this in turn is to be relieved by 10-grain (0.65) doses of the bromides. 

In pruritus pudendi vel ani and vulvce a solution of 4 to 6 grains* 
(0.25-0.40) to the ounce (32.0) should be painted with a camel's-hair 
brush over the parts to relieve the itching. The application is to be 
made from two to four times a day. 

Bed-sores may be aborted if, as soon as the skin reddens, a solu- 
tion of nitrate of silver of the strength of 20 grains (1.3) to the 
ounce (32.0) is applied with a brush to the part. This measure fails 
in paralytics. 

Boils which begin in a small limited papule with a surrounding 
area of inflammation may be aborted by the use of a strong solution 
of this salt. 

In granular lids, conjunctivitis, and similar affections about the eye 
nitrate of silver in stick form or in solution is largely and success- 
fully employed. (See Conjunctivitis.) 

When it is desired to remove nitrate-of-silver stains, they should 
be washed with a solution made of cyanide of potassium 2|- drachms 
(10.0), iodine 15 grains (1.0), and water 3 ounces (96.0). 

Administration. — The dose of nitrate of silver is -J- to J of a grain 
(0.01-0.015) in pill form. Mitigated caustic, or diluted nitrate of 
silver {Argenti Nitras JDilutus, V. S. ; Argenti et Potassii Nitras, 
B. P.), is composed of equal parts of nitrate of silver and potassium 
nitrate, and is used as a mild caustic. 

The drug when given continuously should be discontinued for two 
weeks at the end of the fourth week, as it is so slowly eliminated as to 
accumulate in the body and cause argyria, but Lewin asserts that the 
smallest aggregate amount on record which produced argyria is one 
ounce. 

NITRIC ACID. 

Nitric Acid {Acidum Mtricum, U. S. and B. P.), the strongest 
and most corrosive of the mineral acids, is a clear liquid, becoming 
slightly yellow with age, which acts, when in pure form, upon the 
tissues of the body as a powerful caustic. It should be kept in dark, 
glass-stoppered bottles. Applied to the mucous membranes, well 
diluted, it acts as an irritant or astringent, and when taken internally 



NITRIC ACID. 267 

exerts a stimulating influence over the secretory glands of the stomach 
and small intestines. 

It does not tend to relax the bowels, as does nitro-hydrochloric acid. 

Poisoning. — When nitric acid is taken in concentrated form it pro- 
duces a widespread gastro-enteritis, great pain in the mouth, oesoph- 
agus, and abdomen, and finally death, from the inflammation induced 
or from collapse. If the patient survives the acute stages, he may 
die from secondary changes in the stomach and bowels, such as stric- 
ture or destruction of the peptic tubules. The stain made by the acid 
about the mouth and clothes is deep lemon-yellow. Renal irritation 
is often a severe symptom, and the passages from the bowels and the 
urine may be bloody. 

The antidotes are any alkali of a mild type, as magnesium, chalk, 
or whitewash from the walls of the room, the use of oils and opium to 
relieve irritation, and the proper maintenance of bodily heat. 

Therapeutics. — Nitric acid is used externally in medicine as a 
caustic for chancres and chancroids, the surrounding tissues being 
protected by oils or ointments. 

It may also be used on warts, in cases of gangrene to destroy the 
tissues, and on phagedenic ulcers. Whenever the acid is to be applied 
for such purposes, a solution of soap and water should be at hand to 
neutralize its effects as soon as it has acted deeply enough. Nitric 
acid is also used externally in a dilute form, 5 to 30 drops (0.35— 
0.65) to the ounce, as a stimulant and astringent to indolent ulcers. 
Internally, nitric acid is used as a tonic and astringent. In the 
oxalic-acid diathesis when oxaluria is present, nitric acid Avill give 
relief when nitro-muriatic acid cannot be obtained, although the latter 
is far preferable. When small ulcers exist in the mouth or stomatitis 
is present, 3 drops (0.25) of nitric acid at a dose, in water, will often 
be of service, but it should be taken through a tube to protect the 
teeth. In gastric indigestion in which, soon after a meal, sour food 
regurgitates into the mouth, a few drops of nitric acid will often give 
relief. In intestinal dyspepsia coming on some hours after meals, and 
in which not only discomfort but pain may be felt in the hypochon- 
drium, nitric acid with some simple bitter tonic is most efficient, and 
it will often cure the green diarrhoea of children, particularly in the 
summer, bringing about these changes not only by its astringent 
power, but also by its stimulating effect on the intestinal glands. 
Combined with some good pepsin, it will give relief in the chronic 
diarrhoea of children associated with lientery, and in which the stools 
may be pasty or watery and at the same time ill-smelling. 

Ringer recommends the employment of nitric acid in the treat- 
ment of piles. The strong acid should be used, and simply touched 
to one or two points, not swept over the whole surface. The pain is 
very slight, or none at all may be felt. A slough results, and finally 
comes away, leaving a cicatrix which as it contracts diminishes the 
size of the pile. 

The same author also states that a lotion of dilute nitric acid in 
the proportion of -J- to 1 drachm (2.0-4.0) to a pint (500 cc.) of water 
is of service in bleeding hemorrhoids, arresting the bleeding, con- 



268 DRUGS. 

stringing the parts, and relieving the sensation of weight and fulness 
.so often a pressing symptom. 

The dose of dilute nitric acid (Acidum Nitricum Dilutum, U. S. 
and B. P.) is 3 to 15 drops (0.25-1.0), well diluted, and taken through 
.a tube to protect the teeth. 



NITRITE OF POTASSIUM. 

Nitrite of Potassium is a salt used largely in modern medicine to 
lake the place of nitrite of amyl, but it possesses greater stability, and 
is, therefore, more permanent in its effects. It is used for the relief 
of angina pectoris or heart-pang, in the treatment of gastralgia, and 
even in epilepsy. The dose is from 3 to 5 grains (0.25-0.3), although 
much larger doses have been employed. These larger doses are, how- 
ever, not devoid of danger. Nitrite of potassium is eliminated by the 
lungs and by the kidneys as a nitrate. 

Cobalto-nitrite of Potassium. 

This preparation has been suggested and tried successfully as a sub- 
stitute for the nitrite of potassium. As it is a more stable compound, 
it is less rapidly broken up in the system, and so exercises a more pro- 
longed influence. For this reason it does not act so vigorously or 
suddenly, which is a great advantage in some cases. Its use is iden- 
tical with that of the rest of the nitrite group. The dose of cobalto- 
nitrite of potassium is \ grain (0.03) every three hours. 



NITRO-GLYCERIN. 

Nitro-glycerin is a compound which, in its pure state, is used largely 
as an explosive, but it is employed in medicine in a dilute form as a 
useful drug in those instances where a somewhat rapid and powerful 
effect is to be exercised over the vascular system. Its physiological 
action is identical with that of the other nitrites, such as the amyl 
nitrite, except that it is not so fugacious as the latter, nor so persistent 
in its effects as the nitrites of sodium and potassium. The dose is 1 
to 2 drops (0.06-0.12) of a 1 per cent, solution in a little water or in 
a pill, and no more than this may be employed at one dose unless the 
patient takes the remedy for a considerable period of time, when as 
much as 60 drops may be administered. Often good results are only 
obtained by giving ascending doses. It is noteworthy that patients 
rapidly become immune to the drug, and Reading has recorded a 
•case in which, after a year of treatment, 1 drachm (4.0) of a 10 per 
cent, solution was taken daily with good effect. The drug is largely 
employed in angina pectoris, and sometimes in epilepsy and chorea and 
in gastralgia. DaCosta and others have highly recommended this 
•drug in the treatment of chronic parenchymatous nephritis, as it very 
distinctly decreases the escape of albumin from the kidneys. In 



NITRO-HYDROCHLORIC ACID. 269 

interstitial nephritis, with cardiac disturbance resulting from the 
renal changes, in which there is a marked increase in arterial pres- 
sure, so that auscultation reveals at the second right costal cartilage 
an accentuated second sound due to the forcible closure of the aortic 
leaflets, nitroglycerin often produces a good effect by reducing the 
pressure and relieving the heart of strain. When attacks of angina 
pectoris seem to be accompanied or preceded by marked vascular spasm, 
nitro-glycerin is also indicated. In cases of asthma dependent upon 
engorgement of the mucous membranes of the bronchial tubes it is 
very serviceable. Humphreys asserts that nitro-glycerin is a most 
valuable drug in vomiting of all kinds, except that of pregnancy and 
peritonitis. The solution used in medicine is too weak to be explo- 
sive. Tablets of nitro-glycerin (Tabellce Nitro-glycerini, B. P.) each 
contain y^- of a grain (0.0006). Nitro-glycerin is sometimes called 
trinitrine or glonoin. The U. S. P. of 1890 has introduced a Spiritus 
G-lonoini, which is an alcoholic solution of glonoin. It should be 
kept in tightly-stoppered tins, never in glass, and be stored in a cool 
place, away from heat. Its explosiveness is in direct ratio to the 
evaporation of its alcohol. The dose of the spirit is the same as that 
of the watery solution — namely, 1 to 2 drops (0.05-0.1). The watery- 
solution is not explosive. 



NITRO-HYDROCHLORIC ACID. 

Nitro-hydrochloric Acid (Acidum Nitro-hydrochloricum, U. S.) is a 
liquid giving off a distinct odor, and possessed of a very caustic power, 
staining the tissues of the body a light yellow. It is official in the 
form of the dilute acid {Acidum Nitro-hydrochloricum Dilutum, U. S. 
and B. P.) which is often lemon-yellow, in which case it is useless 
except as an ordinary acid. When we wish to use the acid for its 
own peculiar effects, the official dilute acid ought always to be sup- 
planted by the freshly mixed strong acid and be of an orange color. 
If this cannot be obtained, the physician should prepare the compound 
for himself by adding 4 parts of medicinally pure nitric acid to 16 
parts of hydrochloric acid, and allowing the mixture to stand in an 
open bottle until the fumes are no longer given off in excess, when it 
must be tightly corked and kept in a dark place. This acid ought to 
be freshly prepared every few days. 

Poisoning. — The symptoms caused by poisonous doses are those of 
violent gastroenteritis with vomiting and purging of bloody matters. 
Death may occur from perforation of the alimentary canal, from 
inflammation of the abdominal viscera, and from destruction of the 
peptic tubules or constrictions of the oesophagus or bowel. The treat- 
ment consists in the use of alkalies, such as magnesium, lime, white- 
wash, soap, and oils, with opium to allay irritation. The use of 
external heat to prevent collapse is also to be resorted to. 

Therapeutics. — Nitro-hydrochloric acid is an invaluable remedy in 
many cases of indigestion arising either in the stomach or bowels, as 
it acts as a tonic and stimulant to secretion. Upon the biliary flow 



270 DRUGS. 

its action is quite marked, and it may even cause bilious purging if 
pushed to any extent. It is therefore largely used in hepatic torpor, 
either acute or chronic, and in the early stages of hepatic cirrhosis 
should always be resorted to. In the chronic hepatitis of hot climates 
it is exceedingly useful, but it is not to be employed in acute sthenic 
hepatitis, as it is a stimulant to the liver, which, under these condi- 
tions, needs quieting. When used in chronic hepatitis it should be 
given in full dose and pushed to its physiological limit, as evidenced by 
the bilious purging produced or by signs of gastro-intestinal irritation. 

A useful additional means for obtaining the beneficial effects of 
this acid is to use it by means of the foot-bath or general bath. As 
used by Johnson in India, the acid for this bath is prepared by slowly 
and carefully adding together 2 parts of nitric acid, 3 parts of hydro- 
chloric acid, and after twenty minutes mix carefully with these dis- 
tilled water 5 parts. For the general bath (in a wooden tub) take 5 
pailfuls of water, 64 fluidounces (2 litres +) of the acid mixture, and 
enough boiling water to raise the temperature to 98°. Keep the 
patient in the bath twenty minutes. Then rub him thoroughly with 
warm towels and place him in a dry, warm bed. For the foot-bath 
add 6 ounces (180.0) of the acid to 2 gallons (7 litres) of water at 
98°, and bathe the thighs and calves of the legs for twenty minutes 
with a sponge wet with the mixture. This is a very useful treatment, 
according to Stille, for cases of alcoholic hepatic torpor. If in either 
case the skin becomes irritated less acid is to be used. 

In ordinary so-called biliousness, which is not biliousness, but 
intestinal indigestion, this acid is often of great service. (See Indi- 
gestion and Biliousness.) It is also of value in dysenteric diarrhoea 
where the dysentery rests upon defective secretory action on the 
part of the glands which pour out the proper fluids for digestion. 

Another very important action of nitrohydrochloric acid is the re- 
medial influence it exerts in cases suffering from oxaluria, particularly 
if this be associated with melancholia or great depression of spirits. 

Administration. — The strong freshly-mixed acid should be given 
to the adult in the dose of 1 to 3 drops (0.05-0.18) three times a day, 
well diluted, and taken through a tube after meals. If the patient is 
intelligent, he should be ordered J ounce (16.0) of the pure acid and 
told how to drop it. If he is not, the physician must order it partly 
or entirely diluted in the prescription, and in so small an amount 
that it may be renewed before it loses any of its power. Warning 
should be given of its effects on any clothes with which it may come 
in contact, and care should be taken that the bottle is held some dis- 
tance away from the face when the cork is withdrawn, as the acid, if 
it is fresh, may spurt out and burn the eyes and face. 



NITROUS OXIDE. 

This gas is obtained by a complicated process which requires the 
use of such cumbersome apparatus that its manufacture is out of the 
question for the ordinary practitioner of medicine, while the fact that 



NUTMEG. 271 

several large firms prepare the gas and sell it in cylinders ready for 
use renders its preparation on a small scale unnecessary. The gas is 
devoid of odor, but possesses a slightly sweet taste. 

Physiological Action. — Owing to the symptoms sometimes produced 
in patients inhaling this gas, it has received the popular name of 
"laughing gas," but a condition of hilarity is rarely seen when the 
inhalations are full and deep, and only comes on in the majority of 
cases where the gas is taken in small amounts or very slowly. When 
used properly, the patient is directed to take long deep inspirations 
from the tube placed in the mouth, the nose being held so that the 
nostrils are closed. Under these circumstances the face becomes for 
a moment flushed, then of a deadly pallor, and finally the jaw drops 
if the effect is very great. At this time anaesthesia is complete and 
the operation is to be rapidly performed. 

According to the most recent studies upon this gas (Wood and 
Cerna), it causes at first a rise of arterial pressure, followed by a fall 
if the asphyxia caused by its inhalation is very severe. The anaes- 
thesia is probably chiefly due to the non-oxygenation of the blood 
during the time the gas is in this fluid, or, in other words, it is largely 
due to asphyxiation. It has been thought that the use of this drug 
produces temporary glycosuria, but recent studies render this doubt- 
ful, to say the least. Where permanent glycosuria has been pro- 
duced, some injury to the vascular system in the region of the dia- 
betic centre in the floor of the fourth ventricle has in all probability 
occurred. The gas ought not to be given to those w T ho are advanced 
in years or have atheromatous blood-vessels, since the rise of arterial 
pressure consequent upon the asphyxia may rupture a cerebral blood- 
vessel and thereby cause an apoplexy. Nitrous oxide gas when 
inhaled very rarely produces any disagreeable after-effects, save a 
little light-headed sensation or dizziness for a few r hours. 

Therapeutics. — Nitrous oxide is a useful anaesthetic in all minor 
operations, such as opening an abscess, boil, or felon, or even ampu- 
tating a thumb. It possesses two disadvantages, the first of which is 
its brevity of action, since its continued administration is dangerous ; 
the other, the difficulty in carrying it about from place to place. It 
possesses a great advantage in almost absolute safety, very few deaths 
having been caused by it directly. It is the safest of all anaesthetics, 
not even excepting cocaine, which latter drug has largely supplanted 
the gas for many minor surgical operations. When teeth are to be 
extracted, a plug or cork is placed between the jaws before the gas 
is given, to keep them apart. Under these circumstances the cork 
should always be attached to a string, so that if it slips into the back 
part of the mouth it may be withdrawn before it chokes the patient 
to death. 

NUTMEG. 

Myristica, U. S. and B. P., or Nutmeg, is the kernel of the seed 
of Myristica Fragrans, an East and West Indian plant, mace being 
the outside covering of the same. Nutmeg is a soporific and nervous 



272 DRUGS. 

sedative, exercising a peculiar influence over the cerebrum. It is 
also used as a flavoring substance in somnifacient mixtures, and is of 
value in prescriptions for serous diarrhoea. The oil {Oleum Myris- 
ticos, U. S. and B. P.) is given in the dose of 1 to 3 drops (0.05- 
0.15). The spirit or essence (Spiritus Myristicce, U. S. and B. P.) 
is used in the dose of 1 to 2 fluidrachms (4.0-8.0). 

Several cases of poisoning by nutmeg are reported, the most recent 
by Dr. Reading of Woodbury, N. J. The symptoms closely resem- 
ble those produced by excessive doses of cannabis indica. 



NUX VOMICA. 

Nux Vomica ( U. S. and B. P.) is the seeds or beans of the Strych- 
nos Nux-vomica, an East Indian tree. It contains two alkaloids, 
strychnine and brucine, and depends largely for its medicinal power 
on the former. For this reason the statements made in regard to the 
physiological action of strychnine may practically be considered as 
applicable to the entire drug. 

Physiological Action. — When strychnine is given to man or the 
lower animals in full medicinal dose it increases reflex activity, res- 
piratory rate, pulse-force, arterial pressure, acuity of vision and hear- 
ing, and causes general systemic irritation or excitement. 

Nervous System. — On the nervous system strychnine exerts its 
chief influence. It excites the spinal cord in its motor tracts, and 
probably increases the receptive activity of the sensory centres. It 
also has some slight influence in increasing the conductive power of 
the motor and sensory nerves. 

In overdose strychnine produces spinal or tetanic convulsions by 
an action exerted on the spinal cord. When enormous doses are 
given intravenously, total paralysis, resembling that caused by curare, 
precedes the convulsions, and if artificial respiration is not used the 
animal dies from failure of respiration. If death takes place from 
the effects of the drug, the motor nerves are found to be depressed, 
partly as the result of the poisonous action of the strychnine, and 
partly as the result of the exhaustion of the nerve-trunks by the con- 
vulsing impulses which they have carried. 

Circulation. — Nux vomica increases the force of the pulse-beat 
and the pulse-rate by a stimulation of the heart-muscle and its gan- 
glia, while the rise of arterial pressure which it causes is due to 
stimulation of the vasomotor centre. If very poisonous doses are 
injected intravenously, a fall of arterial pressure occurs instead of a 
rise, which is due to vasomotor depression and paralysis. 

Respiration. — Strychnine is. one of the most constant and pow- 
erful stimulants to the respiratory centre that we have, and it not 
only increases the rate, but the respiratory capacity. 

Temperature. — Ordinary doses have no effect upon temperature, 
but poisonous doses may raise it by reason of the convulsions. 

Elimination. — Strychnine is eliminated from the body by the 



NUX VOMICA. 273 

kidneys as strychnine and strychnic acid. Most of it is oxidized and 
destroyed by the liver. 

Poisoning. — When a poisonous dose of strychnine is taken, it acts 
either suddenly or gradually. If suddenly, the man or animal may 
be, without any premonition, thrown several feet and become rigid 
by contraction of his muscles. 

If the onset is gradual, some stiffness at the back of the neck and 
uneasy startings may precede the general nerve-storm. The convul- 
sions are tetanic, or, in other words, tonic, and the body is thrown 
into opisthotonos ; that is, resting on the head and heels at each con- 
vulsion. 

Sometimes the trunk is twisted sideways or with the back in the 
air (emprosthotonos). The eyes are open and fixed, the corners of 
the mouth drawn back into risus sardonicus, and respiration during 
a severe convulsion is impossible, owing to the respiratory muscles 
being in a state of tetanic rigidity. 

The slightest noise, draught of air, or touch may cause a convul- 
sion or convulsion after convulsion, because the sensory impulse, 
reaching the spinal cord, causes a spasmodic motor impulse to be sent 
out to the muscles. 

The convulsions are not absolutely continuous, but periods of utter 
or partial relaxation occur, during which the patient breathes easily. 
The cramp-like contractions of the muscles are exceedingly painful, 
and the patient either dies of cramp asphyxia — that is, through fail- 
ure of respiration because his chest-muscles are locked in spasm — 
or, much more rarely, from exhaustion. Reichert has shown that it 
requires five hundred times the ordinary fatal dose of strychnine to 
cause death if artificial respiration is properly maintained. 

Treatment of Poisoning. — The attendant should give at once, if no 
symptoms have yet appeared, inhalations of nitrite of amyl, and mean- 
while employ the stomach-pump, using the nitrite to prevent any con- 
vulsive tendencies during the operation. Draughts of water contain- 
ing tannic acid, as the chemical antidote, are to be administered, and 
after the stomach is washed out 60 grains (4.0) of bromide of potas- 
sium and 20 grains (1.3) of chloral in solution are to be given. 
These are the physiological antidotes, for the bromide of potassium 
depresses the sensory side of the spinal cord, and the chloral depresses 
the motor tracts. If the convulsions prevent swallowing, the patient 
must be chloroformed with care, and the physiological antidotes given 
in starch-water by the rectum, muscular relaxation being maintained 
by the anaesthetic until the drugs are absorbed. Ether cannot be used 
as a relaxant, as it is too irritant and too slow. Nitrite of amyl is 
also a physiological antidote, but it is useless if a complete convulsive 
attack is present, as it cannot be inhaled if the chest is immovable. 
Neither can any other relaxant, such as chloroform, be used under 
these circumstances. These drugs should be gently given between the 
paroxysms. If relaxation does not occur, the nitrite of amyl should 
be injected hypodermically. 

While a light touch may produce a spasm, a firm, hard grasp of 
the limb often relieves the pain of the cramp. Sensation and con- 
is 



274 DRUGS. 

sciousness are preserved in strychnine poisoning unless the asphyxia 
destroys them. 

Differential Diagnosis. — The convulsions of strychnine poisoning 
do not resemble epilepsy, because they are so distinctly tonic and 
never clonic. From tetanus strychnine poisoning is to be separated 
by the fact that in tetanus the locking of the jaws comes first, while 
in strychnine poisoning it comes last. The convulsions of tetanus 
rarely, if ever, completely relax, while those of strychnine do have 
periods of relaxation. There is a different histoi^y in each case — in 
one perhaps of an injury, as of a nail run into the foot ; in the other, 
of a dose of poison having been swallowed. 

The differential diagnosis of strychnine poisoning from hysterical 
convulsions is more difficult. The convulsions are rarely so persist- 
ently tonic in hysteria, and the peculiar expression of the hysterical 
face is often seen in such cases. The history of the patient, if obtain- 
able, will throw much light on the case and aid very materially in the 
separation of the two conditions, while the peculiar variations in 
cutaneous sensibility which are so characteristic of hysteria may 
render the diagnosis possible. 

As the treatment of all these states is virtually identical, the 
employment of the measures just suggested may be resorted to in 
each instance, and the diagnosis made afterward. 

Therapeutics. — Nux vomica, or its chief alkaloid strychnine, is 
used for several purposes in medicine. Owing to its bitter character- 
istics it may be employed as a simple bitter tonic or as one especially 
influencing the nervous system. It may also be used as a respiratory, 
cardiac, and ocular stimulant. 

In cases of functional nervous atony, or depression, strychnine 
does good, but in organic disease, if used during the period of acute 
inflammation, as after an apoplexy or in acute infantile palsy, it is 
distinctly harmful. Some cases of apoplexy can never take the drug 
without a spasm coming on in the paralyzed part or parts. In acute 
or subacute neuritis strychnine ought never to be used in any way 
whatever, as the nerves are already inflamed, and are not to be still 
further irritated by the employment of nervous excitants. In pro- 
gressive lead palsy large doses of strychnine should be constantly used 
to stop the progress of the disease, iodide of potassium also being 
employed to cause the elimination of the lead. 

In amaurosis dependent upon the excessive use of tobacco or alco- 
hol strychnine is almost a specific, and in eye-strain resulting from 
insufficiency of the ocular muscles it does great good, curing the insuf- 
ficiency and improving the general condition of the muscles. Accord- 
ing to De Schweinitz, the patient should use ascending doses of the 
tincture of nux vomica, beginning with 3 drops (0.15) three times a 
day, and increase the amount 2 drops (0.1) a day until distinct 
physiological effects are produced. Sometimes 60 drops (4.0) may 
be used in twenty-four hours after tolerance is reached. 

In pneumonia and all other acute diseases in which sudden collapse 
is liable to occur strychnine is of the greatest service at the time of 
need. Often it will pull the patient out of a sinking attack which 



OPIUM. 275 

seems certain to end in death. It should be used freely by the hypo- 
dermic needle, and is often improved in its effects by the addition of 
T5T to tm grain (0.0004-0.0006) of atropine to each injection. (See 
Pneumonia and Shock.) 

There is no drug known which is so antidotal to the effects of 
overdoses of chloroform as is strychnine. In cases of sudden acci- 
dent, with arrest of the heart or respiration during the use of this 
anaesthetic, the physician should give hypodermic injections of fa grain 
(0.006) of strychnine as a powerful, rapidly-acting cardiac and respi- 
ratory stimulant, which close may be repeated in ten minutes if no 
effect is produced. Strychnine is a very valuable remedy in surgical 
shock, and is a better antidote to opium than is belladonna. 

In dyspnoea from any cause, such as that of old persons with win- 
ter cough or bronchorrhoea, in emphysema, phthisis, and in shortness of 
breath, strychnine is of service, and it is a valuable drug for the treat- 
ment of opium-poisoning, because it preserves the reflexes and stimu- 
lates the respiratory centre. 

In atony of the bowels strychnine is of service, and it is to be added 
to purgative pills to avoid their depressing after-effect on the intestines. 

In cases in which a lesion exists in the brain, strychnine may be 
used to keep up the nutrition of a limb which is paralyzed, but if the 
palsy be due to disease of the trophic cells in the spinal cord, it does 
little good except to stimulate the remaining cells to greater effort. 

According- to Ringer, sick headaches, due to errors in diet and 
without much nausea, can be put aside for the day by the use of 1 
drop (0.05) of the tincture of mix vomica in a teaspoonful (4.0) of 
water every five or ten minutes until 10 drops (0.65) are taken. 

Untoward Effects. — Care should be exercised in giving strychnine 
to children, as they are more susceptible to the drug than are adults. 
The proper beginning dose of strychnine by the mouth for a child of 
five or six is not more than -fa-$ grain (0.0006), In some cases of ex- 
hausting disease the prolonged use of full doses of strychnine may pro- 
duce a talkative delirium with great peevishness, and, if the drug is 
continued, this condition may pass into a state of temporary insanity. 

Administration. — The extract of nux vomica (Extractum Nucis 
Vomicae, U. S. and B. P.) is given in the dose of \ to J- of a grain 
(0.01-0.016); the fluid extract {Extractum Nucis Vomicce Fluidum, 
U. S.), in the dose of 1 to 5 drops (0.05-0.3) ; the tincture (Tinctura 
Nucis Vomicce, U. S. and B. P.), in the dose of 5 to 30 drops (0.3- 
2.0), Strychnince Sulphas, U. S. and B. P., is given hypodermically 
in the dose of fa to fa of a grain (0.002-0.003), and by the mouth 
in the same amounts. In cases of severe surgical shock as much as 
i grain (0.016) may be used hypodermically. 

OPIUM. 

Opium (£7. S. and B. P.) is the juice or milky exudation appear- 
ing on the surface of the unripe capsules of white poppy or Papaver 
Somniferum, a native plant 'of Asia, now grown in many other parts 
of the world. 

Good opium, according to the TJ. S. P., should contain at least 9 



276 DRUGS. 

per cent of morphine, but the powdered opium (Pidvis Opii, U. S.) 
should contain not less than 13 or more than 15 per cent, of morphine. 

The chemical composition of this drug is very complex, no less 
than seventeen alkaloids having been obtained from it, the most 
important of which are morphine, codeine, narcotine, thebaine, nar- 
ceine, papaverine, pseudomorphine, and laudanine. It also contains 
meconic acid and meconine. 

Physiological Action. — Opium, when given in full dose, produces 
in the lower animals, such as the frog, violent spinal convulsions ; in 
the dog, great increase in reflex activity ; and in man, deep sleep, the 
spinal symptoms being in abeyance. 

Nervous System — Opium has a double action on the nervous 
system. It quiets the brain, but excites the spinal cord if given in 
very large doses. In the frog, which has no brain of any size, the 
spinal action predominates ; in man, whose brain is proportionately 
larger than his spinal cord, the cerebral effect is the dominant influ- 
ence. In the animals between the frog and man opium either pro- 
duces convulsions and sleep or sleep alone. If the dose is large, the 
spinal cord becomes depressed in all animals and the reflexes faiL 
The motor nerve-endings are also somewhat depressed under these 
circumstances, but the sensory nerves generally escape. 

Circulation. — Small therapeutic doses of opium have no effect 
upon the circulation, but large ones slow the pulse, increase its force, 
raise arterial pressure, and cause the respirations to become deepened 
and more full and at the same time a little slower. 

The slowing of the pulse depends upon stimulation of the pneumo- 
gastric nerves peripherally and centrically ; the increase in pulse-force 
rests upon the stimulation of the heart-muscle and its ganglia ; the 
rise of pressure is due to the increased heart-action and vasomotor 
stimulation. 

After poisonous doses all these changes become more marked, and 
finally go on into a rapid-running pulse and great depression, due to a 
reversal of all the influences named ; the vasomotor centre is depressed, 
as are also the pneumogastric nerves. 

Respiration. — In very minute doses opium is a feeble stimulant, 
or at least not a depressant, to the function of respiration. In over- 
dose it is one of the most powerful paralyzants of the respiratory cen- 
tres in the medulla oblongata, causing death in this way. 

Temperature. — The bodily temperature is raised slightly by full 
doses and lowered by poisonous amounts of opium. 

Tissue-waste. — Opium acts as a preventive to tissue-waste, 
decreasing the elimination of urea and other results of nitrogenous 
breakdown. 

Elimination. — The drug escapes, if given in excess as morphine, 
chiefly by way of the intestines and kidneys, but most of it is destroyed 
in the body. Experiments made by Alt and Tauber show that mor- 
phine is chiefly eliminated by the stomach, and that if this viscus is 
frequently washed out during a case of poisoning, recovery is much 
aided, as by this means reabsorption is prevented. 

Pupil. — Opium contracts the pupils by a centric stimulation of 



OPIUM. 277 

the oculomotor nerves, and perhaps by depression of the sympathetic 
fibres. 

Stomach, Intestines, and Secretion. — Opium depresses the 
motor activity of the stomach and intestines and produces constipa- 
tion. It does this by stimulating the splanchnic inhibitory fibres of 
the intestine and thereby preventing peristalsis. In very large doses 
it increases peristalsis by paralyzing these fibres. 

Opium checks every secretion in the body except that of the 
skin. 

Acute Poisoning. — When opium is taken by man in overdose it 
causes drowsiness, deep sleep, full breathing, a slow, full pulse, a 
w T arm, dry skin, contracted pupils, and pleasant — or, more commonly, 
in the Anglo-Saxon race, disagreeable — dreams or no dreams at all. 

Preceding this period there may be a brief one during which the 
person feels self-satisfied and contented. The duration of this agree- 
able sensation only lasts a short time, and if the dose is large does 
not occur or at once passes off. It has been called the first stage, 
while the more marked symptoms just described have been grouped 
into a so-called second stage. 

During the sleep of the second stage the patient can be roused by 
shouting in his ear or by violent shaking, but sinks back into slumber 
at once on being left alone. 

The face is suffused and reddened, and may be finally distinctly 
cyanotic. Many of the symptoms resemble those of congestion of the 
brain. The breathing may be puffing and stertorous. When the 
patient is awakened he breathes more rapidly, and for this reason the 
duskiness of the face disappears and the normal hue returns. Death 
never occurs in the second stage of opium poisoning from the poison 
alone, but if a complicating disease is present death may take place 
at this time. 

The third or fatal stage emerges from the second by a process so 
gradual that no abrupt line of separation can be noted. The face 
becomes at first more cyanotic, then pale and livid ; the respirations, 
which have been eight to ten to the minute, are now only four or five, 
and finally such prolonged pauses occur that all hope of another res- 
piration is lost by the attendant. While the slow breathing is at first 
deep, it now rapidly becomes shallow, and muscular relaxation is 
present to the greatest degree. The skin, previously dry, is wet 
with the sweat of death, the patient is so deeply narcotized that 
nothing can arouse him, and he dies from respiratory failure, although 
the heart ceases almost simultaneously from the asphyxia. The pupils 
do not dilate in the third stage, except in the relaxation of death. 

Treatment of Acute Poisoning. — After employing the usual 
methods resorted to for the purpose of unloading the stomach, and 
after giving permanganate of potassium or tannic acid, preferably the 
former, as the chemical antidote, the patient should receive one or 
two cups of strong black coffee, hot and concentrated. The heat in 
the liquid is useful in maintaining bodily temperature, and the caf- 
feine stimulates the respiratory centre and keeps the man awake. 
•Coffee should be used even before any symptoms come on, in order to 



278 DRUGS. 

put them off if possible. If atropine be at hand and the respirations 
are becoming very slow, -j-J^ to gL- of a grain (0.0006-0.001) should 
be given hypodermically, but this dose should not be repeated after 
the respirations increase to ten or twelve, and atropine is not a pow- 
erful physiological antagonist. Strychnine is, however, much better 
than atropine as an antidote to opium, and should be given hypoder- 
mically in full dose, repeated frequently enough to keep the nervous 
system of the patient active and respiration intact. The pupil is no 
guide as to the action of atropine, as the action of these two drugs 
(opium and atropine) on the eye is not antagonistic. 

Alcoholic stimulants may be called for, and ammonia as a cardiac 
and respiratory stimulant may be resorted to. 

In the third stage heat should be applied to the trunk and extrem- 
ities. 

Much emphasis has been placed on keeping the patient awake, 
and it has been thought that the cause of death was the deep sleep. 
This is not so. The man must be kept awake in order that he will 
supplement the efforts of his depressed respiratory centres by volun- 
tary breathing. If he sleeps, he forgets to breathe, and sleep means 
death for this reason, and not because sleep in itself produces death. 

Besides the use of the hot strong coffee, the patient may be kept 
awake by lashing him with switches or by keeping him walking up 
and down between two attendants. Both of these measures are rep- 
rehensible if anything better can be done — the first method because it 
covers the patient with cuts and bruises, the second because it may 
aid in the production of death by exhaustion. If an ordinary med- 
ical faradic battery is at hand, the full force of the current may be 
allowed to come in contact with the skin from two small poles wet 
with salt water, or, better still, the dry or wire electric brush should 
be swept over the body while the negative pole is held in the hand of 
the patient or pressed against his skin. This causes the most exqui- 
site pain in the normal individual, but if the brush is kept moving 
will not cause any bruises or discoloration. (See Asphyxia.) Arti- 
ficial respiration may be resorted to. 

Chronic Poisoning. — Morphine or opium when taken constantly 
generates a habit. The person — or morphine-habitue, as he is some- 
times called — depends for a comfortable existence on the drug, and 
day by day increases bis dose until the most extraordinary amounts 
are taken by the stomach or by means of the hypodermic needle. If 
the drug is withheld, a train of symptoms typifying depression or 
exhaustion ensues. The pulse is scarcely to be felt, horrible mental 
depression and melancholia come on, the miserable man or woman 
wrings his or her hands, and begs, screams, howls, or yells for mor- 
phine, only to break down and cry on being refused the customary 
dose. Diarrhoea of a serous type and most violent in character, with 
cramps in the muscles, may assert itself, and must be controlled by 
astringents and an active line of treatment as far as possible free 
from opium. (See Diarrhoea.) 

A characteristic symptom of chronic opium-eating is the develop- 
ment of the most remarkable and clever lying in previously truthful 



OPIUM. 279 

persons. In the same breath that the patient begs the physician to 
cure hirn, and not give him another dose of morphine, he will lie to 
obtain the drug in a surreptitious manner, and mav even have the 
drug in his mouth at the moment he speaks. It will often be found 
hidden in the seams of the clothing in small packages, and the nurse 
should be absolutely reliable, and for ever on the watch lest the drug 
be obtained by smuggling. Any sudden improvement on the part of 
the patient should be placed to the credit of more morphine, not to 
professional skill. 

Treatment. — The best way to treat such cases is to "taper off*" 
the daily dose, and to decrease by a sixth or a fourth the total cus- 
tomary amount in each twenty-four hours. The sudden complete 
withdrawal of the drug is an unnecessarily severe measure, and its 
withdrawal in a slower manner than that named is simply prolonging 
the treatment beyond reasonable limits. Cocaine has been used to 
tide over the crisis after the withdrawal of morphine, but too fre- 
quently the patient passes from opium to the cocaine, and finally to 
the alcohol, habit, all of which are equally bad. If the circulation 
flags, digitalis and strychnine may be given and the remaining symp- 
toms treated as common sense indicates. 

Sometimes paregoric is taken in excess, and the writer has seen 
and treated a case in which over a pint of paregoric was taken every 
day. 

When a mother is an opium-eater, the newborn child often suffers 
from collapse on the second or third clay after its birth, owing to the 
lack of its customary dose of opium. 

Therapeutics. — Opium is used for relief of five great conditions^ 
which will be spoken of seriatim, the minor uses of the drug being 
considered afterward : 

Pain. — Opium, as is known to every one, is the best remedy that 
we possess for the relief of all forms of pain, except in those instances 
where neuralgia exists, when antipyrine and its fellow-compounds 
exceed it in medicinal value. In one form of pain opium is not to 
be employed — namely, that arising from cerebral congestion and cere- 
britis, for it is distinctly contrainclicated in these affections, as it 
makes them worse. In acute or traumatic meningitis, however, opium 
is of great service, either alone or combined with mercury in sthenic 
cases. In the treatment of cases of renal and hepatic colic associated 
with spasm, and in dysmenorrhea, belladonna and opium given 
together will relieve the spasm and pain, and yet so counteract each 
other elsewhere in the body as to be devoid of effect upon other 
organs. Persons suffering from pain will always bear very much 
larger amounts of opium than painless individuals. 

Insomnia. — Opium, while capable of producing sleep in almost 
every case in which it is given, save in those persons who by reason 
of idiosyncrasy are made wakeful by it, is only to be used in those 
instances where the sleeplessness is due to pain. If constantly used 
in insomnia or pain, the opium habit is rapidly contracted, and for 
this reason the use of the drug should be alternated with chloral, 
cannabis indica, and other soporific drugs. 



280 DRUGS. 

In some cases chloral and morphine, when given in small doses in 
combination, will so act upon the brain as to produce sleep. 

In the insomnia of typhoid fever, opium may be used, particularly 
during convalescence, but it must be employed most carefully. 

Inflammation and Irritation. — Opium seems to possess some 
influence over inflammation which we cannot explain, and both small 
and large doses are particularly valuable in inflammations of serous 
membranes, such as peritonitis, meningitis, and pericarditis. It allays 
the nervous excitement and anxiety following haemoptysis, and the 
intense unrest caused by itching shin diseases, as, for example, the 
irritation of small-pox. Sometimes intense irritation or inflammation 
produces so great an effect upon unstriped muscular fibres as to cause 
spasm or paralysis, as in retention of urine, cystitis, or the constipa- 
tion following inflammation of the bowels from irritating foods ; 
under these circumstances the employment of opium is indicated, 
and is usually very successful. In irritative coughs morphine given 
in syrup of wild-cherry bark does good in the dose of y 1 ^- to -^ of a 
grain (0.005). 

Opium should rarely be employed in haemoptysis, as it increases 
the blood-pressure, and in this manner an increased flow of blood 
from the ruptured vessel. (See Haemoptysis.) 

In some cases of irritable cough due to tickling in the larynx a 
drachm or two of paregoric added to hot water and the steam inhaled 
gives great relief. 

Whenever the cough is in excess of the expectoration — that is, 
greater than is necessary to free the lung from mucus — morphine may 
be given in small doses. If the lungs contain more rales after than 
before its use, it must be stopped, as the increase in the number of 
rales indicates an increase in the accumulation of mucus. 

In the treatment of strangury and rectal inflammation, provided 
they are not acute, after operation on the pelvic organs, and in cys- 
titis, suppositories in the strength of J or J of a grain (0.016-0.03) 
of the watery extract of opium are very useful. In excessive vomit- 
ing from any cause, except it be from a previous dose of opium, 
enemata of deodorized laudanum 30 drops (2.0) and starch-water 4 
ounces (128.0), with 20 grains (1.3) of bromide of sodium, will be 
found of value. (See Vomiting.) 

For sprains and bruises lead-water-and-laudanum is one of the best 
applications. If the skin is broken, laudanum may be used alone to 
relieve pain, and, by its alcohol, to act as an antiseptic. Opium is 
also a useful drug in the treatment of internal and external burns to 
relieve the pain and irritation. 

Over-secretion. — In serous diarrhoea, diabetes insijndns and mel- 
litus, and in the treatment of over-secretion on the part of all secret- 
ing surfaces except the skin, opium may be used. 

It is said to decrease the amount of urine before decreasing the 
amount of the sugar in diabetes. However this may be, the employ- 
ment of morphine or codeine in diabetes is a very valuable form of 
treatment. The doses should be rapidly increased, as the effect is 
only obtained under such circumstances, and diabetic patients seem 



OPIUM. 281 

peculiarly immune to the nervous influence of these drugs. Mor- 
phine is, therapeutically, the more powerful of the two alkaloids. 
Neither of them, probably, cures the disease, but so modifies it as 
to make life bearable and happy. (See article on Diabetes, Part IV.) 

Opium should not be used in mucous diarrhoea until after the 
mucus already present is swept out of the intestinal canal by castor 
oil or magnesium sulphate. Minute doses of -£§ to -^ of a grain 
(0.001) of morphine will sometimes check summer diarrhoea in chil- 
dren at once when given hypodermically. 

Systemic Strain. — In prolonged strain upon the system, as in 
great physical effort, or more frequently in old age to smooth out the 
cares of the remaining years of life and decrease worry, opium is 
useful. In asthenic fevers it is thought to be supportive, but its use is 
apt to cause so many other conditions, such as constipation, anorexia, 
or mental depression, that alcohol is much better for this purpose. In 
very advanced phthisis it is often justifiable to give enough opium to 
keep the patient free from pain and discomfort for the remaining 
hours of his life, but care must be taken that the dose does not inter- 
fere with his breathing and so hasten death. 

In muscular rheumatism and similar states, where a "cold" has 
been taken, opium in the form of Dover's powder will often produce 
a cure, particularly if employed in combination with hot drinks and a 
hot foot-bath. 

In heart disease, particularly of the mitral valves, the patient can 
often breathe easily only when awake, starting up when he falls 
asleep and gasping for breath. It is stated by some writers that 
morphine will relieve this state and permit sleep, but that it will 
not be of service in aortic disease. While this may be partly true, 
the drug will often give great relief in all forms of cardiac dyspnoea, 
and ought always to be tried. Care should be taken that the first 
dose is small, as in some instances it increases the discomfort. The 
relief obtained is supposed to be due to cardiac stimulation by the 
drug, and, while this is no doubt correct, other cardiac stimulants, 
such as digitalis, will fail when morphine succeeds. The presence of 
cyanosis and lividity is said to be no contraindication to the hypo- 
dermic use of morphine under these circumstances, provided the dose 
is not unreasonably large. 

Administration. — Recent studies upon the action of opium and its 
alkaloids show that it acts in an inhibitory manner upon gastric diges- 
tion and absorption, decreasing the amount of hydrochloric acid in 
the gastric juice. Unless there is an excess of acid present, it is well 
not to give opium or morphine at meal-times, but some hours after. 

Opium itself is used in the form of the powder (Pulvis Opii, U. S.) 
in the dose of from \ to 1 grain (0.016-0.05). The solid preparations 
are the deodorized opium {Opium Deodoratum, U. #.), which is deprived 
of its narcotine, dose J to 1 grain (0.03-0.05); the pills of opium 
{PiluloB Opii, U. S.), each containing 1 grain (0.05); and the watery 
extract (JExtr actum Opii, XI. S. and B. P.), dose \ to J a grain (0.016- 
0.03). Of the liquid preparations we have paregoric [Tinctura Opii 
Camphorata, U. S. ; Tinctura Camphoros Composita, B. P.), dose 1 



282 DRUGS. 

drachm to 2 tablespoonfuls (4.0-32,0); laudanum (Tinctura Opii, 
U. S. and^. P.), dose 10 to 30 drops (0.65-2.0); the deodorized 
tincture [Tinctura Opii Deodorati, U. S.), dose 10 to 30 drops (0.65- 
2.0) ; the Vinum Opii, U. S. and B. P. — or, as it is sometimes called, 
Sydenham's Laudanum — dose 10 to 30 drops (0.65-2.0); and Acetum 
Opii, U. S., or Black Drop, dose 10 to 30 drops (0.65-2.0). 

Under the name of Dover's Powder (Pulvis Ipecacuanha? et Opii, 
U. S.) a powder containing 1 grain (0.05) of powdered opium, 1 
grain (0.05) of powdered ipecac, and 8 grains (0.50) of sugar of milk 
is largely used. This is more efficacious if separated into fifths and 
taken in divided doses. The tincture of ipecac and opium {Tinctura 
Ipecacuanha? et Opii, U. S.) is given in the dose of 4 to 15 minims 
(0.3-1.0). 

All the liquid preparations of opium are of 10 per cent, strength, 
except paregoric, which is about 2 grains to the ounce. 

The preparations of opium official in the B. P., other than those 
named, are — Confectio Opii, close 5 to 20 grains (0.3-1.3) ; Extractum 
Opii Liquidum, dose 4 to 20 minims (0.3-1.3); Pulvis Opii Com- 
positus, composed of opium, pepper, ginger, caraway-fruit, and trag- 
acanth, dose 2 to 5 grains (0.1-0.35) ; Tinctura Opii Ammoniata, dose 
i to 1 drachm (2.0-4.0); and Trochisci Opii ( T V grain [0.006] of 
opium in each), dose one to four. 

Pilula Saponis Composita, B. P., is purely a preparation of opium. 
It is sometimes necessary to give this drug to patients without their 
knowledge, and it may be prescribed in this way, the patient not 
learning from the prescription the nature of the medicine. 

The B. P. also recognizes a liniment (Linimentum Opii) and a 
plaster (Emplastrum Opii) for local application, and an enema {Enema 
Opii), composed of J a drachm (2.0) of the tincture of opium and 2 
ounces (64.0) of starch mucilage. 

Ordinary opium is apt to produce nausea and depression, as already 
stated, but the deodorized opium is not so apt to produce these symp- 
toms, since it is deprived of the narcotine found in the crude drug. 
The deodorized laudanum is substituted for the ordinary laudanum 
for the same reasons. Morphine is used to relieve pain rather than 
opium, because it does not cause so much constipation, but opium is 
better to check diarrhoea. Paregoric is particularly useful in diar- 
rhoea because it contains a volatile oil and camphor. 

Untoward Effects. — Opium in many persons produces after its 
primary influence great nausea, and sometimes vomiting. The men- 
tal depression may be simply overwhelming, and the very fact of 
having to drag out existence is a curse. These symptoms are said to 
be largely done away with by the use of 20 grains (1.3) of bromide of 
potassium, which must be taken at the same time as the opiate, and 
by employing the preparations of opium largely devoid of narcotine, 
such as the deodorized tincture or deodorized opium itself. Haig is 
responsible for the assertion that, as opium frees the blood of uric 
acid by causing its retention in the tissues of the body, the pleasant 
effects are so produced, and that, the retention being cumulative, no 
sooner does the effect of the opiate pass off than the uric acid is set 



OPIUM. 283 

free in the blood, and as a result depression ensues. He states that 
if salicylates are given with the opium the retention does not occur, 
and the unpleasant sequelae are much modified or prevented. By 
far the most effective mode of preventing these very distressing effects 
of opium or its derivatives is to administer with this drug about -g-J-g- 
grain of nitroglycerin. After the untoward symptoms come on 
coffee and stimulants may be used. 

Children bear opium badly, and some children are very much more 
susceptible than others to its influence. 

One-eighth grain of morphine has caused death in an adult when 
given hypodermically. Sometimes the drug causes collapse, or in 
other cases an eruption over the body. 

Codeine. 
(See p. 159.) 

Morphine. 

Morphina, TJ. S. and B. P., is the chief alkaloid of opium, but 
owing to its insolubility is rarely used. 

Sulphate of Morphine (Morphince Sulphas, TJ. S. and B. P.) is 
given in the dose of \ to J grain (0.008-0.03), either by the mouth 
or hypodermically. Besides the sulphate of morphine we have the 
acetate (Morphince Acetas, TJ. S. and B. P.) and the muriate (Mor- 
phince Hydrochloras, TJ. S. and B. P.), both given in the dose of J 
to J grain (0.008-0.03). In the U. S. Pharmacopoeia of 1870 a solution 
(Liquor Morphince Sulphatis, B. P.), was official, dose 1 to 2 drachms 
(4.0-8.0), but it is no longer official and should not be called for. 
Magendie's solution is sixteen times as strong as this liquor (16 grains 
to the ounce), and is not official, The words " Liquor Morphinse 
Sulphatis " will generally cause Magendie's solution to be dispensed 
in New York State, and care should be taken that poisoning does not 
result. Pulvis Morphince Compositus, TJ. S., or Tully's Powder, is 
given in the dose of 10 grains (0.65) ; troches of morphine and ipecac 
(Trochisci Morphince et Ipecacuanha?, TJ. S.) are given one or two at 
a time. 

The following additional preparations of morphine are official in 
the B. P. : Liquor Morphince Hydrochloratis, dose 10 to 40 minims 
(0.65-2.65); Tinctura Chloroformi et Morphince, dose 5 to 10 minims 
(0.35-0.65) ; Suppositoria Morphince and Suppositoria Morphince cum 
Sapone, each suppository containing J grain (0.03) of morphine; 
Trochisci Morphince and Trochisci Morphince et Ipecacuanha?, each 
lozenge containing -gig- of a grain (0.002) of morphine, close 1 to 4. 
Liquor Morphince Acetatis is given in 20- to 40-minim (2.65) doses. 
Injectio Morphince Hypo dermic a, B. P., contains 1 grain (0.05) of 
the acetate of morphine in each 10 minims (0.65) of water. 

It is said by Alt that morphine when given hypodermically is elim- 
inated by the stomach, and so causes nausea, but if the stomach be 
well washed out this is avoided. 

Incompatibles. — Morphine is incompatible with tannic or gallic acid 
or astringent solutions containing them, with alkalies, such as potas- 



284 DRUGS. 

sium, sodium, and ammonium, but with the chloride of ammonium it 
is not incompatible. With tincture of chloride of iron it forms a 
deep red color (meconic acid). 

OX-GALL. 

Inspissated Ox-gall (Fel Bovis, U. S.) is, as its name implies, 
dried ox-bile. It is used in medicine for the purpose of relieving 
certain forms of indigestion which depend upon deficient secretion 
of bile or which occur in persons who digest fats with difficulty. In 
full doses it is apt to cause some looseness of the bowels, and it may 
be given with this object. When it is used the fact should be remem- 
bered that bile prevents the gastric juice from acting upon proteid or 
albuminous substances, shrivelling them up, and in addition so alter- 
ing the gastric liquids as to decrease their digestive power. We 
learn, therefore, that this drug must be administered some hours after 
meals as a rule, or, in other words, when gastric digestion is ended 
and intestinal activity is beginning. The dose of inspissated ox-gall, 
which is dried by evaporation from 100 to 15 parts, is 5 to 15 grains 
(0.35-1.0). Purified Ox-gall (Fel Bovis Pur ificatum, U. S. ; Fel 
Bovinum Purificatum, B. P.) is given in the same dose as the inspis- 
sated bile. It is made by evaporating 3 parts of pure ox-gall to 1 
part, and then adding to this part an equal amount of alcohol, which 
constituents are mixed thoroughly, and after standing twenty-four 
hours the clear liquid is decanted and the residue is evaporated to a 
consistency capable of forming a pill. 

OXIDE OP ZINC. 

Commercial Oxide of Zinc (Zinci Oxidum Yenale) is not used in 
medicine, but in the purified form is largely employed in the shape 
of Zinci Oxidum, U. S. and B. P., which is insoluble in water. In 
the form of the oxide-of-zinc ointment ( Unguentum Zinci Oxidi, U. S. 
and B. P.) this drug affords one of the most generally used applica- 
tions in the treatment of skin diseases, burns, and sores. 

In all states where the surface of the skin is dry it is contraindi- 
cated, but where the eruption is moist it is useful. In the treatment 
of the chloasma of pregnancy the following prescription is of service : 

R. — Zinci oxidi gr. iij (0.18). 

Hydrarg. ammoniat gr. j (0.06). 

Olei theobromse ^ijss (10.0). 

Olei ricini gijss (10.0). 

Essent. rosss gtt. x (0.65).— M. 

S. — Apply to the face night and morning. 

In eczema with many vesicles use — 

R. — Pulv. camphorse .......... ^ss (2.0). 

Pulv. zinc, oxidi ^iij (12.0). 

Glycerini gtt. xl (2.65). 

Adipis'benzoinati Sj (32.0).— M. 

S. — Apply to the part without other treatment or precede it by powdered bis- 
muth. 



OXYGEN. 285 

In powdered form zinc oxide is useful in the treatment of inter- 
trigo and in conjunctivitis. With bismuth subnitrate and pepsin it is 
largely used by some practitioners in the treatment of the summer 
diarrhoea of infants or adults. 

In the night-sweats of debility or phthisis oxide of zinc in the fol- 
lowing formula has been highly recommended, but probably depends 
largely for its action on the second ingredient : 

& .— Zinci oxidi gr. xxx (2.0). 

Extract, belladonnse . . gr. iij (0.18). — M. 

Ft. in pil. No. x. 
S. — One at night before going to bed. 

Bartholow recommends the oxide of zinc for cases of asthma and 
whooping cough, given to an adult in the manner just indicated. 



OXYGEN, OXYGEN- WATER. 

The gas Oxygen is now widely used in medical and surgical prac- 
tice in three forms, as follows : By the inhalation of the gas itself 
from a cylinder in which it is compressed until 40 gallons occupy a 
very small space ; by drinking oxygen-water, which is distilled water 
saturated with the gas ; and finally, by the use of the dioxide or 
peroxide of hydrogen, which is applied locally to diseased surfaces. 
(See Hydrogen Peroxide.) 

Inhalations of oxygen are useful in the second and third stages 
of pneumonia where the patient is about to die from deficient aeration 
of the blood, with resulting heart-distention. They are also of value 
in advanced bronchitis, particularly that of old persons, and for the 
resuscitation of persons asphyxiated by coal-gas (Hare and Martin). 
In phthisis and other exhausting diseases oxygen will allay dyspnoea 
and oppression. 

In the preparation of the solution of oxygen gas the water must 
be distilled, so that it may be as free as possible from other gases. 
The bottling should be done under a pressure of 150 to 200 pounds, 
and the contents drawn off by means of a tap such as is used in 
siphons or for champagne bottles. Birch of England has found that 
the addition of a little nitrous-oxide gas to this water adds piquancy 
to its taste and increases its stimulating effects. The value of this 
preparation is undoubted, and when taken into the body it has proved 
of the greatest service in chronic dyspepsia, persistent vomiting, and 
headaches both digestive and neuralgic. 

In constipation depending upon intestinal atony oxygen gas is said 
to give relief if it is taken in solution just before going to bed. It 
is hardly necessary to' state that the water should be swallowed as 
soon as possible after it is taken out of the bottle which has contained 
it. In some cases where general systemic torpor is present oxygen- 
water taken after each meal, or even more frequently, may be used 
with advantage. One or two tumblerfuls may be taken each time. 



286 DRUGS. 

PANCREATIN AND PANCREATIC EXTRACTS. 

Under these names a number of firms now sell an extract from the 
pancreatic gland or juice, and the TJ. S. P. recognizes the name of 
Pancreatinum. It contains, or should contain, the four pancreatic 
ferments — trypsin, which digests proteids (meat, eggs, etc.) ; steapsin, 
which splits up and emulsifies the fats ; arnylopsin, which has dia- 
static power (that is, converts starch into sugar), and finally, a milk- 
curdling ferment. 

A preparation equally useful with the commercial pancreatin may 
be made by the physician in the following manner : 

Take the pancreas of a pig which has been killed about six hours 
after a full meal, the organ being therefore active, and, after chopping 
it up finely, add to it four times its weight of dilute alcohol and allow 
it to stand for twelve hours. Decant or filter off the alcohol, and 
give the filtrate in the dose of 1 to 2 drachms (4.0-8.0). Or, better 
still, as follows : Wash and chop up finely a fresh pancreas, and allow 
the gland to soak in alcohol (absolute) twenty-four to forty-eight hours. 
After this squeeze out the alcohol and add to the gland ten times its 
weight of glycerin. This must stand forty-eight hours and then be 
filtered and be used in doses of 30 drops (2.0) to each glass of milk. 
(See Peptonized Foods.) 

Some doubt has been cast upon the usefulness of the employment 
of pancreatin in foods unless this ferment was allowed to act upon the 
aliment before it was swallowed by the patient, on the ground that 
pancreatin is destroyed and rendered inert in the presence of an acid. 
This objection is not a valid one, because food remains in the stomach 
for from fifteen minutes to half an hour before enough gastric juice is 
secreted to interfere with the pancreatic action. It is during this 
preliminary period that the work of the pancreatin is accomplished. 



PAPAIN, PAPAYOTIN, AND PAPOID. 

Papain, Papayotin, and Papoid are names given to a digestive fer- 
ment derived from the juice of Carica Papaya. This ferment pos- 
sesses the power of changing proteids into peptones in the presence 
of an acid or an alkali, or even in a neutral mixture, thereby differ- 
ing from pepsin and pancreatin. This power would be of very great 
value, since the drug would then be useful in all forms of dyspepsia, 
were it not that careful experimentation renders it doubtful as to 
whether papain, papayotin, or papoid can really supplant either of 
the animal ferments named above. The dose of all these products is 
from 1 to 8 grains (0.05-0.6) in solution, or better in pill. The plant 
has the reputation of being capable of causing abortion. 



PARALDEHYDE. 

Paraldeliydum, TJ. S. and B. P., is a form of aldehyde used as a 
soporific and nervous sedative, and is a clear, colorless liquid with an 



PENTAL. 287 

ethereal odor and a burning, followed by a cool, taste. It should be 
kept in dark well-stoppered bottles in a cool place. Paraldehyde is 
readily soluble in alcohol, moderately so in water, less so in hot 
water. It possesses the great disadvantages of being necessarily 
given in large dose and having a disagreeable taste and odor. It is 
-also very apt to disorder the stomach. Paraldehyde kills when taken 
in overdose by respiratory failure, but is not so depressant to the 
heart as is chloral. It requires frequent repetition and soon loses its 
power. The dose is 20 drops to 1 drachm (1.3-4.0) in capsules, or, 
tetter still, it may be used, after the formula of Yvon, as follows : 

R.— Paraldehyde .^ijss (10.0). 

Alcoholis (90 per cent.) f ^jss (45.0). 

Tincturse vanilla3 f.^ss (2.0). 

Aqua> f&j (32.0). 

Syrupi simplicis q. s.ad f^iv (128.0). — M. 

S. — A dessertspoonful (8.0) every half-hour until sleep is obtained. 



PAREIRA. 

Pareira, U. S. (Pareiroe Radix, B. P.), is the root of Ohondoden- 
dron Tomentosum, a plant of Peru and Brazil, and is used as a diu- 
retic of an alterative or stimulant character and for the relief of 
chronic inflammations of the genitourinary type in general, such as 
pyelitis, cystitis of a subacute type, and similar pathological states. 
The dose of the unofficial infusion is a wineglassful (32.0), and the 
fluid extract (Extractum Pareiroe Fluidum, U. S.) is given in the 
dose of a teaspoonful (4.0) three times a day. The B. P. prepara- 
tions of this drug are — the decoction (Becoctum Pareiroe), dose 1 to 
2 ounces (32.0-64.0); the extract (Extr actum Pareiroe), dose 10 to 
20 grains (0.65-1.3); and Bxtr actum Pareiroe Biquidum, dose 1 to 2 
drachms (4.0-8.0). 



PENTAL. 

Pental is an impure amylene first described in 1844 and used in 
1856. It at once dropped out of notice until a few years ago, when 
it was brought forward as an anaesthetic for use in minor or brief 
operations. Pental is a colorless liquid, insoluble in water, but read- 
ily mixed with ether, chloroform, or alcohol. It is very inflammable, 
but not affected by exposure to light and air. 

Physiological Action. — Our knowledge of the physiological action 
of pental is exceedingly limited. Wood and Cerna, from a very 
incomplete and imperfect study, conclude that it is a powerful cardiac 
and respiratory poison. 

Therapeutics. — Pental is to be employed by means of a Junker 
inhaler if its use is continued for any length of time. If it is to be 
taken for a few minutes, an ordinary chloroform mask or towel may 
be used. The quantity to be employed for the production of anaesthesia 
is about 2 to 3 drachms (8.0-12.0). Pental is an anaesthetic which 



288 DRUGS. 

so far promises very little, and which will probably be used by a very 
limited number of practitioners, as it possesses no particular advan- 
tages over older and safer anaesthetics. It is, however, right to state 
that some surgeons employ it with great satisfaction. Thus Phillip 
asserts that it is regarded as indispensable in the Children's Hospital 
of Berlin, as it acts very rapidly, produces little excitement, and per- 
mits rapid return to consciousness. It has been given in this insti- 
tution one thousand times. 



PEPO. 

Pepo, U. S., Pumpkin-seed, the seed of the ordinary domestic 
pumpkin, is a useful and efficient vermifuge against the tape-worm. 
The seeds are not only efficient, but harmless to the host of the worm. 
The outer coverings of the seeds should be removed, and the remain- 
ing part rubbed up into an emulsion with water or into an electuary 
with sugar, the dose of the seed being 2 ounces (64.0). This mass 
should be taken on an empty stomach, and followed in from one to 
two hours by an active purge. 



PEPPER. 

Piper, JJ. S., or Black Pepper (Piper Nigrum, B. P.), is the 
unripe fruit of Piper Nigrum, a vine of India, Java, Borneo, and 
Siam. It contains an alkaloid, piperine, which is official. 

Therapeutics. — Black pepper may be used as a counter-irritant or 
internally as a carminative and stimulant to the alimentary canal. 

It may also be used in all cases of atony of the mucous membranes 
of the genito-urinary system, but is contraindicated whenever acute 
inflammation is present, as in acute gonorrhoea. It may be used in 
the treatment of great flatulence, with marked relief. 

Piperine (Piperinum, JJ. S.) has been used as an antiperiodic with 
varying success, and is given in the dose of 1 to 5 grains (0.05-0.35). 
The oleoresin (Oleoresina Piperis, JJ. S.) is given in the dose of -J- 
to 2 drops (0.016-0.1) in laxative pills, to prevent griping. A con- 
fection (Confectio Piperis) is official in the B. P., given in the dose 
of 1 to 2 drachms (4.0-8.0). 



PEPPERMINT. 

Mentha Piperita, JJ. S., is official in the form of the leaves and 
tops. It has an aromatic odor and taste. Locally applied, the oil 
acts as an irritant and local anaesthetic. From this oil is obtained 
menthol, a camphoraceous substance of a hot burning taste, possess- 
ing marked power as a local anaesthetic. (See Menthol on next page.) 

Therapeutics. — Peppermint is used very largely as a domestic rem- 
edy for flatulence and infantile colic. Sometimes the oil is added to 



PEPPERMINT. 289 

purgative pills to prevent griping, and it may be employed to cover 
the taste of many medicines which are disagreeable to take. In this 
respect it is used as are all the volatile oils. In the colic of children 
of six months to a year, when it is unusually severe and associated 
with nervous symptoms, the following will be found of value : 

R.— Chloralis gr. xvj (1.0). 

Potassii broraidi gr. xxxij (2.0). 

Aq. menth. piperit fgij (64.0). — M. 

S. — Teaspoonful (4.0) in a little warm water every four hours. 

When used in the treatment of neuralgia, oil of peppermint should 
be placed on a piece of linen or muslin rag and applied over the 
affected spot. Care must be taken that it does not blister the skin. 
If, after its removal, the burning" is too severe to be borne, a little 
cosmoline or olive oil should be applied. Oil of peppermint is 
sometimes placed on cotton and inserted into dental cavities for 
toothache. 

It is to be remembered that the more menthol is present in the oil 
the more active will it be as an anaesthetic, and that the Chinese oil 
contains more menthol than the American oil. 

Administration. — Peppermint is used in the form of the oil (Oleum 
Menthce Piperita*, U. S. and B. P.), dose 1 to 4 drops (0.05-0.25); 
the spirit (Spiritus Menthce Piperita?, U. S. and B. P.), dose 10 to 
30 drops (0.65-2.0); the water (Aquce Menthce. Piperitce, U. S. and 
B. P.), dose 1 to 2 drachms (4.0-8.0); and, finally, as the Troches 
(Trochisci Menthce Piperitce, JJ. $.), to be held in the mouth in indef- 
inite number. Essentia Menthce Piperitce, B, P., is given in the 
dose of 10 to 20 minims (0.65-1.3). 

Menthol. 

Menthol, U. S., or Mint Stearopten, or, as it is sometimes called, 
Mint Camphor, is derived chiefly from the essential oil of peppermint. 
It occurs in colorless prismatic crystals with a strong odor of pepper- 
mint. Upon it rests much, if not all, of the therapeutic activity of 
peppermint. Menthol is slightly soluble in water, very soluble in 
alcohol, ether, and in oils. 

Menthol has been used in the vomiting of pregnancy with great 
advantage in hourly doses of a teaspoonful of the following : 

R.— Menthol gr. xv (1.0). 

Spt. frumenti f^vj (24.0). 

Syrupi f 3J (32.0). 

Menthol has also been used as a carminative and in gastralgia in 
the dose of from 1 to 2 grains (0.05-0.1) three times a day in pill or 
in alcoholic solution. It is contraindicated in acute inflammation of 
the gastric mucous membrane. 

As menthol exercises a local anaesthetic effect on the skin as w T ell 
as on mucous membranes, it is used externally over the course of 
neuralgic nerves and in migraine. 

Menthol when used as a depletant on the mucous membranes of 

19 



290 DRUGS. 

the throat or nose causes a contraction of the local blood-vessels, 
which is not followed by the excessive dilatation produced by cocaine 
when used for similar purposes. In acute coryza its local application 
to the mucous membrane by a spray or dropper is often a source of 
great relief in a solution of about 1 grain (0.05) to the ounce (32.0) 
of water, or, better still, 3 grains (0.25) of menthol in J an ounce 
(16.0) of albolene. 

Another very useful method of applying menthol is by means of a 
simple inhaler consisting of a small glass tube of about one-quarter 
of an inch in diameter and two and a half inches in length. Both 
ends are closed by a piece of gauze and two perforated corks, the 
menthol being placed in between. The air is now drawn through 
this tube, and, being heavily loaded with the fumes, clears the nostril 
and relieves the stuffiness. It is not to be only smelled, but inhaled. 
Care should be taken that the crystals are not allowed to enter the 
nostril, as they are almost cauterant in power. Sometimes, where 
great excoriation of the alse of the nose exists, the too persistent use 
of the menthol may produce small herpetic spots about the nostrils. 

Emplastrum Menthol, B. P., is used as a mild local irritant and 
anaesthetic. 

PEPSIN. 

Pepsinum, IT. S. and B. P., is the digestive ferment of the gas- 
tric juice. That sold in the shops is generally derived from the pig, 
and is prepared by many persons in many ways. Much of the pep- 
sin of the market contains more peptone than pepsin, and much 
mucus and albumin. Used with hydrochloric acid in weak solution, 
it carries out the digestive action of the stomach. Pepsin containing 
peptone has the peculiar musty smell of peptone, and if the peptone 
is in excess will absorb moisture and become sticky on exposure to 
the air. 

Therapeutics. — Pepsin is a much-overrated remedy for indigestion. 
Pancreatin will always be found more serviceable, and should be 
given either immediately or one or two hours after meals. Pepsin 
should be used immediately after the food or with it. Hydrochloric 
acid should always be given, as its presence converts any pepsinogen 
in the gastric tubules into pepsin. Pepsin is official in the IT. S. P. 
as Pepsinum and Pepsinum Saccharatum. The dose of the latter 
must be 20 to 30 grains (1.3-2.0), to be of any service. It is a 
weak and almost useless preparation, made up chiefly of milk-sugar. 
Liquor Pepsini is given in the dose of 2 drachms (8.0). Pure pepsin 
should be given in 5- to 15-grain (0.35-1.0) doses. 

According to the IT. S. P. of 1890 official pepsin must have the 
power to digest three thousand times its weight of albumin. 



PERMANGANATE OP POTASSIUM. 

Potassii Permanganas, IT. S. and B. P., is a salt of a dark pur- 
plish-red color, appearing in small crystals and readily soluble in 



PETROLATUM. 291 

water. In the presence of moisture it rapidly gives up the oxygen 
which it contains and becomes the binoxide of manganese. 

By reason of this oxidizing power the permanganate of potassium 
is largely used as an antiseptic and deodorant. It should not be 
employed as a disinfectant, because its action is too fleeting, but in 
saturated solution, followed by oxalic-acid solution, it proves itself the 
best disinfectant for the hands in surgical practice. (See Antisepsis.) 

Permanganate of potassium is given in the same dose for amenor- 
rhea as the binoxide of manganese, but is much less efficacious. It 
is also very apt to irritate the stomach. 

The permanganate is thought to be useful in dyspepsia, flatulence, 
lithcemia, and obesity, and in the former states is certainly of service, 
being a destroyer of the abnormal products by oxidation. Owing to 
this oxidizing power, it has been asserted by Weir Mitchell and 
Reichert to be the most efficient antidote to snake-venom if placed in 
the wound before the poison is absorbed. It should also be injected 
hypodermically about the bite. Permanganate of potassium is the best 
antidote in poisoning by morphine and that caused by many other 
vegetable alkaloids. Owing to its rapid absorption of oxygen, it acts 
as an antiseptic, and may be used in the washing of wounds, ulcers, 
and sores, and as a lotion in the form of a gargle or on a swab in 
diphtheria and scarlet fever. The solution used should be from 20 to 
60 grains (1.3-4.0) to the pint (J litre) ; the former is used on mucous 
membranes, the latter for sores and wounds. In foetid rhinitis and 
otitis media permanganate solution is useful as a wash in the propor- 
tion of 1 grain (0.05) to the ounce (32.0). When given in solution 
permanganate of potassium should be dissolved in distilled water, and 
it should never be mixed in a mortar with any organic matter, as it 
will explode. A solution {Liquor Potassii Permanganas) is official in 
the B. P. 

PETROLATUM. 

Under the name of Petrolatum Molle, U. S., or Soft Petrola- 
tum, or Unguentum Petrolei, is sold a semi-solid substance derived 
from certain kinds of petroleum, and sometimes called Cosmoline or 
Vaseline. 

Owing to its soothing powers and non-rancidity, it is used as an 
emollient dressing in sores and skin affections. It has no value 
except as a protective, and may be given in capsules in cases of gas- 
trointestinal irritation in any quantity as a soothing treatment. It 
does not affect the passages from the bowels and is not absorbed, 
although assertions to the contrary have been made. 

Cosmoline is a useful vehicle for medicines for the skin. Under 
the name of fluid or liquid petrolatum (Petrolatum Liquidum, TJ. S.) 
a fluid form is sold, which is much used in the form of a spray in the 
treatment of rhinitis and after irritant applications to the nasal 
cavities. 

The U. S. P. now recognizes, in addition to these two preparations, 
Petrolatum Spissum, which has the consistence of a cerate. 



292 DRUGS. 

PHBNACETIN, or ACETPHBNETIDIN. 

Phenacetin (Phenacetinum, B. P.) is a coal-tar product introduced 
several years ago as an antipyretic of the same character as antipy- 
rine, and, while more apt to disintegrate the blood than the latter 
drug when given in large amounts, is not very dangerous, because its 
influence upon other vital parts is not severe. 

When this drug is carelessly made an impure product is the result, 
which produces irritation of the kidneys, and, in consequence, causes 
grave complications. Reuter states that the impurity may be dis- 
covered by placing a small amount of chloral hydrate in a test-tube, 
melting it at the temperature just sufficient to liquefy it, and then 
adding the suspected sample of phenacetin in the proportion of one- 
fifth. If the phenacetin is impure, it will become purple, then red, 
and finally blue. 

Physiological Action. — Unfortunately, our knowledge of the phys- 
iological action of phenacetin upon the nervous system is not as 
thorough as is desirable. We know, however, that it is a distinct 
nervous sedative, and that it acts particularly on the spinal cord in its 
sensory path. 

Upon the circulation the drug has little or no effect, unless given 
in doses far above those generally employed or continued in over- 
dose for some time. The blood after the ingestion of these doses 
becomes dark and blackish from the formation of metheemoglobin, 
and the urine becomes dark yellow and reacts with Fehling's solu- 
tion. Upon normal bodily heat and the heat of fever the drug 
exerts a depressing effect, decreasing the production and dissipation 
of heat. 

Therapeutics. — Our knowledge concerning the influence of phen- 
acetin upon the human body in disease may be divided into two 
separate parts, in much the same manner that we divide antipyrine — 
namely, its uses as an antipyretic and as an analgesic. 

Like the other members of the antipyretic group which are. blessed 
with this double action, its antipyretic influences were first observed, 
and shall therefore first be spoken of. 

The employment of this drug in medicine was first attempted by 
Hinsberg and Kast, who from the very first spoke of it in the highest 
terms of praise. They found that it seldom, if ever, caused serious 
untoward effects, and that its power over fever, in the dose of from 3 
to 8 grains (0.15-0.5), was quite extraordinary. Very shortly after 
the paper of these writers appeared Kohler published the report of 
its use in some fifty cases in the clinic of Bamberger of Vienna, the 
febrile affections being tuberculosis, pneumonia, typhoid fever, pleurisy, 
and several other diseases of like character. He found, as have most 
of his successors, that the fall of fever does not occur for nearly half 
an hour after the dose is taken, and that the stage of apyrexia con- 
tinues for from four to eight hours afterward. 

As a general rule, sweating was not noted as being present to any 
great extent, but in phthisis and advanced typhoid fever there can be 
no doubt that chilliness and an abnormal fall of temperature may 



PHENACETIN. 293 

come on. Cyanosis and vomiting did not occur in a single one of 
Kohler's cases. In a very instructive case of pneumonia due to septic 
infection in a patient of twenty years phenacetin not only lowered 
the fever, but in addition decreased, to a large extent, the blood in 
the urine, and did not in the slightest degree influence the kidneys 
unfavorably. That the drug has power is evidenced by the fact that 
Kohler used it only when the temperature reached as high as 103°, 
104°, or 105° F., and in these cases the temperature fell not less than 
from three to five degrees. 

It is a very important fact to be remembered that morning doses 
of phenacetin seldom have as powerful an influence as evening doses. 
Two morning doses are only equal to one evening dose in most cases, 
and it would seem better in phthisis to give the drug about noon to 
prevent the evening exacerbation of temperature than to resort to it 
at a time nearer the pyrexial period. 

The conclusions of Kohler have been confirmed by Hoppe in a 
long series of studies, and this writer also points out the deleterious 
excess of apyrexia which sometimes comes on in debilitated cases of 
phthisis under its use. 

One of the advantages of having several drugs belonging to one 
class is the benefit often derived from the use of one where another 
has failed. Thus Hueber found that in several instances phenacetin 
was successful where antipyrine had not acted, and believes it to be 
the more powerful drug of the two — a conclusion also reached by 
Heusner, who thinks that 15 grains (1-0) of phenacetin are equal to 
half as much antifebrin and to 30 grains (2.0) of antipyrine. Lepine, 
who has studied with so much care the other antipyretics, also believes 
it to be superior to them all ; and in this Guttman is largely of the 
same opinion. 

These conclusions are, in the author's belief, far too favorable, for, 
while he has found the drug to possess powerful antipyretic activity 
and to be useful in nearly all the fevers where antipyrine can be 
employed, he does not look upon it with the same degree of con- 
fidence that he does the latter drug when anxious to reduce a fever 
which seems dangerous and worthy of rapid and certain reduction ; 
neither does he believe it to be as safe as antipyrine. 

Upon the nervous system phenacetin acts as an antineuralgic — is 
of service in migraine and ordinary headache from eye-strain, in the 
pains of tabes dorsalis, in intercostal neuralgia, and in rheumatism. 
Sometimes it cures these troubles when antipyrine fails. Altogether, 
we may consider phenacetin a rival of antipyrine in the power to 
relieve pain. 

For neuralgia the following prescription may be ordered : 

R. — Phenacetin. ... 4 gr. x (0.65). 

Caffeinse citratis gr. v (0.35). 

Sacchar. lactis gr. xx (1.3). — M. 

Ft. in chart Xo. t. 
S. — One powder every two hours while pain lasts. 

In subacute rheumatism and in the lumbar or muscular pains of 



294 DRUGS. 

influenza a powder or pill of 4 grains (0.3) of phenacetin and 5 grains 
(0.35) of salol given three or four times a day is most efficient. 



PHBNOCOLL. 

Phenocoll is a compound closely allied to phenacetin. It is 
always used in the form of the hydrochloride of phenocoll, which 
occurs in a fine white powder, quite soluble in water and forming a 
neutral solution. It is incompatible with alkalies. It is used as an 
antipyretic. 

Physiological Action. — A number of studies of the action of phe- 
nocoll hydrochloride upon the animal organism have been made by 
Robert and Von Mering in Europe, and by Wood and Cerna, and 
Ott in America. These investigators have found that it separates 
itself from most of the coal-tar antipyretics in that it has little effect 
on the red blood-corpuscles. It does not cause as great a sweat when 
the fever falls as do its near antipyretic relations. Von Mering has 
shown that phenocoll has little lethal power, but Ott asserts that it 
kills by failure of respiration, and causes paraplegia, cyanosis, and 
depression of the heart in poisonous dose. 

Therapeutics. — Whatever advantages further clinical experience 
will show this drug to possess over its older fellows in the antipyretic 
field, it can never be widely used as a remedy for fever, since no drug 
is now widely employed for this effect except in a limited class of cases. 
As pointed out in the article on the treatment of Fever, antipyretic 
drugs are of little value as compared to bathing. Phenocoll may be 
given for the same purposes and under the same circumstances in the 
presence of fever as can antipyrin or acetanilid, but, like these drugs, 
is contraindicated in advanced exhausting diseases, such as consump- 
tion. A number of clinicians have tried phenocoll hydrochloride for 
the relief of rheumatism and to remove neuralgic pain, with, asserted 
success. As yet it has not been used largely enough to ensure its 
continuance as a remedy of positive value, except in cases of malarial 
fever, in which it seems to possess distinct remedial power. The dose 
of phenocoll hydrochloride is 5 to 8 grains (0.35-0.6) two to five 
times a day. It is best given in capsule. 



PHOSPHATE OP SODIUM. 

Sodii JPhosphas, U. S. and B. P., is a preparation which ought 
never to be used to supplant phosphorus, as it has an entirely differ- 
ent effect. It is particularly useful in bottle-fed children, who continu- 
ally alternate between diarrhoea and constipation, and is also useful 
in rickets. It should be added to each bottle of milk in the dose of 
2 to 4 grains (0.1-0.2). Phosphate of sodium is slightly laxative. 
Bartholow believes phosphate of sodium to be the best remedy that 
we have in hepatic cirrhosis and jaundice. To adults it should be 
given in the dose of 20 grains to 2 drachms (1.3-8.0) once, twice, or 
thrice a day according to the laxative effect desired. 



PHOSPHORUS. 295 

Many cases of wretchedness or headache due to an excess of uric 
acid in the blood are relieved by the phosphate of sodium or of cal- 
cium, since both substances cause the disappearance of the acid from 
the blood, not by causing its elimination, but by causing its deposit 
in the tissues in the form of urates. The use of these so-called acid 
phosphates is therefore ultimately harmful in gouty or rheumatic 
persons. 

PHOSPHIDE OP ZINC. 

Zinci Phosphidum, IT. S., is often used in place of phosphorus, 
owing to its greater stability and readiness of administration. The 
dose is j!q of a grain (0.006) three times a day. It is used in gela- 
tin-coated pills. 

PHOSPHORIC ACID. 

The pure acid is very rarely employed in medicine, but when 
given is used in 2- to 8-drop (0.1-0.5) doses. In the form of dilute 
phosphoric acid (Acidum Phosphor icum Dilutum, IT. 8. and B. P.) 
it is widely employed in the dose of 20 drops to 1 drachm (1.3-4.0) 
as a tonic and gastric stimulant. It is not a food to the nervous sys- 
tem, does not resemble phosphorus in its physiological action, and is 
not to be employed in its place. It does good in nervous exhaustion 
simply by stimulating the stomach and thereby aiding the organ in 
the digestion of food. 

PHOSPHORUS. 

Phosphorus, IT. S. and B. P., is a non-metallic element, gener- 
ally obtained from bones, and is very soluble in oils, less so in ether 
and alcohol. Its odor is very characteristic and peculiar. When 
placed in a dark room after exposure to light it is luminous, and if 
exposed to the air will ignite. It should be kept in tightly-stoppered 
bottles under water. Very commonly it is contaminated by arsenic 
and sulphur. 

Physiological Action. — Phosphorus is found in large amount, com- 
paratively speaking, in the bones and in the nervous system, and is a 
stimulant to the growth of both. It acts, therefore, as a direct tonic 
to nervous tissue and is a producer of bone. Upon tissue-waste the 
drug acts as a depressant, thereby preserving the body, as it decreases 
the elimination of urea and diminishes the quantity of carbonic oxide 
exhaled. 

Upon the growth of bones phosphorus has a most remarkable 
influence, causing, when it is given to young animals, great increase 
in the size of these parts. The first change noted is an enlargement, 
which consists in a jelly-like mass containing little or no bone salts, 
and this is finally converted into a very hard material which may fill 
the entire canal in the centre of the bone. Kissel has stated that this 



296 DRUGS. 

does not occur, but his results must be doubted in view of the thorough 
studies of Wegner. 

Acute and Chronic Poisoning. — When phosphorus is taken in poi- 
sonous dose, often from the ends of matches, no symptoms may come 
on for eight or ten hours. At the end of that time the peculiar taste 
of phosphorus may be noted in the mouth, the breath is heavily 
laden with its odor, and burning pain in the oesophagus, stomach, and 
abdomen ensues. Vomiting and purging now assert themselves, and 
both the matters which are vomited and those which are passed from 
the bowels may be luminous in the dark, owing to the presence of 
phosphorus. The vomit at first consists of food, then mucus, then 
bile, and then perhaps blood. All the symptoms of a mild gastro- 
enteritis may develop, but it is to be noted that constipation of an 
obstinate type may replace the purging. Very soon the liver increases 
in size, and gives rise to general hypochondriac pain and tenderness 
as well as local swelling. At the end of twenty -four hours, or per- 
haps after the second day, a cessation in the symptoms occurs, and, 
if the physician be not on his guard, this will lead him to a hopeful 
prognosis, but in the course of a few hours jaundice begins in the 
conjunctiva and then extends over the entire body. With the onset 
of jaundice the vomiting and pain return with renewed vigor. The 
matters vomited are often the color of " coffee-grounds," due to 
exuded and altered blood. The bowels are absolutely confined, or 
the few hard masses passed are white and clay-like because of the 
absence of biliary coloring matter. There is no bile in the vomit in 
this stage, because the hepatic ducts have been closed by the inflam- 
mation which has been produced in the liver. Later, nervous symp- 
toms ensue. Muscular twitchings, headache, vertigo, wild delirium, 
erotic convulsions, and finally unconsciousness and death, occur. 
Sometimes the convulsions occur just before dissolution. Even if the 
patient survives the acute stage of the poisoning, he generally dies of 
the changes produced in his organism, which consist in widespread 
fatty degeneration. These fatty changes occur even in the acute 
period of the poisoning. Atrophy of the liver, destruction of the 
gastric tubules, pancreatic involvement, and kidney degenerations aid 
in producing the ultimately fatal results. 

During the poisoning by phosphorus the urine is scanty and per- 
haps albuminous, and is peculiar because of the unusual substances 
which are found in it. The most unusual of these is sarcolactic acid, 
which results from the breaking down of the muscular tissues. Leucin 
and tyrosin are also found, and tube-casts with fatty globules in them 
are seen. Free fat-globules may also occur. Bile acids and bile col- 
oring matter are found in large amount, and the urine is generally 
dark-colored for this reason. As phosphorus is eliminated as hypo- 
phosphoric acid, this substance is also present. 

The symptoms of phosphorus poisoning may so closely resemble 
those of acute yellow atrophy of the liver as to make a differential 
diagnosis impossible unless some evidence of the presence of phos- 
phorus is obtainable. 

In chronic poisoning by phosphorus, when, by the inhalation of its 



PHYSOSTIGMA. 297 

fumes, systemic changes occur, the most common lesion is necrosis of 
the lower jaw, which may be widespread or limited. It never occurs 
in those who have no solution of continuity in the teeth or gums, and for 
this reason it is necessary that the employes in match-factories should 
have their teeth constantly attended to. It is said that pans contain- 
ing turpentine when set around the room will protect the workmen, 
but this is certainly incorrect. 

Treatment of Acute Poisoning. — The antidote to phosphorus is 
generally taught to be the sulphate of copper, which will also act as an 
emetic if given in excess, but recent studies made by Thornton in the 
laboratory of Jefferson Medical College prove that it is as dangerous 
a poison as the phosphorus. Peroxide of hydrogen and permanganate 
of potassium are probably the best antidotes. Oil of turpentine, in 
America, is not only valueless as an antidote, but harmful, for only 
old, ozonized French oil of turpentine is antidotal in its influence. 
As phosphorus is soluble in oils, we simply aid in its absorption if 
any such substances are given. 

Therapeutics. — Owing to its influence on the development of bone, 
phosphorus is very useful in rachitis and osteomalacia. It is also 
useful in the sweats of general or nervous debility ancl in nervous 
exhaustion, and in some cases of melancholia depending upon over- 
work. In the course of prolonged exhausting diseases, as typhoid 
fever or typhoid pneumonia, the drug is of service if the nervous 
system seems to be particularly affected, and in convalescence it is of 
service in aiding to build up the shattered forces of a patient. 

In the sequelae of acute and chronic alcoholism and in morphio- 
mania it is of service. Phosphorus is also employed in sexual 
exhaustion or abuse. In boils and carbuncles and similar disorders 
phosphorus is very useful, particularly so in acne indurata. In pneu- 
monia some physicians use minute doses with the belief that it aids in 
the production of resolution, one of the most enthusiastic of these 
being Dr. Boardman Reed. 

In the neuralgia from nerve-depression and in cerebral softening and 
meningitis of a chronic type phosphorus often does good. 

The dose of phosphorus is yJ-Q to -^ of a grain (0.0006-0.0012) 
in pill form (Pilulce Phosphori, U. S. and B. P.), but it may be grad- 
ually pushed to ^L of a grain (0.003) if urgently needed. Phospho- 
rated oil {Oleum Phosphor -atum, U. S. and B. P.) and Spiritus Phos- 
phori, U. $., are given in the dose of 1 to 5 minims (0.05-0.35). 
Elixir Phosphori ( U. S.) is given in the dose of 15 minims to 1 
drachm (1.0-4.0). 

The beginning close of phosphorus should not be above yj^- of a 
grain (0.0006), for fear of some idiosyncrasy. 



PHYSOSTIGMA. 

Physostigma, JJ. S. (Physostigmatis Semen, B. P.), is a seed 
derived from Physostigma Yenenosum, a tree of West Africa, often 
called Calabar bean. It contains two alkaloids, eserine or physostig- 



298 DRUGS. 

mine and calabarine. The former is the most important from a med- 
ical point of view. 

Physiological Action. — Calabar bean is a general paralyzant, but if 
the alkaloid calabarine be present in excess it may be a convulsant. 

Nervous System. — On the spinal cord in poisonous dose this 
drug acts as a direct depressant poison, particularly affecting the 
motor tracts. On the motor nerves it exerts no influence at all unless 
given in large toxic doses, when it depresses their peripheral ends. 
The sensory nerves generally escape, but sometimes even they are 
involved. On the voluntary muscles the drug in these doses causes 
twitchings, due to a direct influence over their fibres. In all medici- 
nal doses the drug is a stimulant to unstriped muscular fibre. 

Circulation. — Calabar bean causes comparatively little circu- 
latory change, but it produces a rise of arterial pressure, based 
largely upon a direct stimulation of the heart, and slows the pulse 
by peripheral stimulation of the cardiac inhibitory nerves. 

Respiration. — In moderate amount Calabar bean causes no inter- 
ference with the respiration, but in poisonous dose produces death by 
paralysis of the respiratory centre. 

Pupil. — Physostigma causes myosis or contraction of the pupil by 
stimulation of the oculo-motor nerves peripherally, by depression of 
the sympathetic fibres, and by causing contraction of the blood-ves- 
sels of the iris. It decreases intra-ocular tension. 

Alimentary Tract. — Physostigma is a stimulant to intestinal 
peristalsis, increasing the muscular activity in the walls of the gut 
and acting as a tonic to these fibres. 

Poisoning. — Calabar bean is used in Africa as an " ordeal bean " 
to determine whether a person is or is not guilty of a crime. If 
an individual eats it and survives he is guiltless, but if he dies he 
is guilty, according to this rather fatalist belief. If he does survive, 
it is generally by reason of the calabarine producing vomiting and 
purging, and so ridding the patient's stomach of the poison before it 
is absorbed. 

Poisonous doses of physostigma cause muscular tremors, followed 
by complete muscular relaxation. The pupils contract, the respira- 
tions become slow and irregular, and all reflex action fails. Vomit- 
ing or purging may or may not occur. 

Treatment of Poisoning:. — This consists in the use of atropine, 
which is the physiological antidote, in the application of heat to the 
body, and the use of respiratory and cardiac stimulants, such as digi- 
talis, alcohol, or ammonia. 

Therapeutics. — Calabar bean is employed in many affections, such 
as trismus neonatorum, tetanus, and other spasms, with only mode- 
rately good results. It is, however, of value in atony of the bladder 
and intestines and in catarrh of the bowels. The author has used it 
with great success in cases of gastric and intestinal dilatation. 

In bronchial asthma and emphysema it will aid in the expulsion 
of the mucus by its influence over the muscular fibres in the walls 
of the air-tubes. It is also useful in purgative pills. (See Consti- 
pation.) 



PILOCARPUS. 299 

Administration. — Physostigma is used in the form of the extract 
(Extr actum Physostigmatis, U. S. and B. P.) in the dose of \ of a 
grain (0.008), which may be readily increased to J of a grain (0.016). 

The tincture (Tinctura Physostigmatis, U. S.) is given in the dose 
of 5 to 20 drops (0.3-1.35). This tincture is twice as strong as that 
official in the U. S. P. of 1880. 

Eserine (Physostigmina, B. P. ; Physostigminoe Salicylas, U. S., 
and Physostigminoe Sulphas, U. S.) may be used in the dose of •£$ 
of a grain (0.0008) three times a day. In the eye, of the strength 
of 1 to 2 grains to the ounce (0.05-0.1 : 32.0) of water, eserine is 
used in the treatment of corneal ulcerations and for the relief of 
glaucomatous states with high intra-ocular tension. If, for any 
reason, atropine mydriasis is to be rapidly overcome, eserine is to be 
used, but it is not so powerful as atropine, and it will require larger 
amounts of the solution to produce contraction than it took of atro- 
pine to cause mydriasis. Lamellce Physostigminoe, B. P., each con- 
tain yoVo °f a g ra i n (0.00006) of physostigmine. Two salts of eser- 
ine or physostigmine are now on the market — namely, the sulphate 
and the salicylate. The former is much more soluble, and is gener- 
ally to be employed. The salicylate is largely used, nevertheless, by 
ophthalmologists. The dose of both salts is T -W to yJir of a grain 
(0.0004-0.0006). 

PILOCARPUS. 

Pilocarpus, U. S. {Jaborandi, B. P.), is derived from the South 
American tree, Pilocarpus Selloanus or Pilocarpus Jaborandi. It 
contains two alkaloids, known as pilocarpine and jaborine, a volatile 
oil, and other minor constituents. The alkaloid pilocarpine is non- 
crystallizable and occurs as a soft mass. The salts of pilocarpine are, 
however, crystallizable. 

Physiological Action. — When jaborandi is taken in medicinal dose 
by a healthy man, it causes a deep flushing of the face and neck, fol- 
lowed by the outbreak of a profuse sweat, which, though beginning 
in these regions, rapidly spreads over the entire body. Accompany- 
ing the sweat, the salivation is often exceedingly profuse, so that 
saliva dribbles from the mouth. Nausea frequently comes on, and 
severe vomiting may appear in susceptible persons either during or 
after the sweating. On the contrary, some individuals are singularly 
insusceptible to the influence of pilocarpus, and this is particularly so, 
according to Ringer, with children, who will often take as much as 
60 grains (4.0) of the crude drug before they perspire. Some adults 
also refuse to yield to its influence. 1 The sweat lasts from three to 
five hours. 

Nervous System. — Moderate doses have no effect on this part of 
the body, but poisonous amounts cause in the frog tetanic reflex con- 
vulsions, and finally paralysis, the latter being due to depression of 

1 The writer has reported a case (see Idiosyncrasy) where a woman of thirty 
years received f of a grain of the muriate of pilocarpine hypodermically in half an 
hour without any effect. 



300 DRUGS. 

the muscles and spinal centres. The nerves escape. Medicinal doses 
in man exercise no effect over the nerves. 

Circulation. — In large doses there is no doubt that jaborandi 
acts as a cardiac depressant rather than as a stimulant, and, while 
there may be no evidence of an experimental character pointing to 
such a conclusion, the fact exists in practical medicine. The drug 
causes in the lower animals a slow pulse and increased arterial pres- 
sure, in moderate quantities, the first change being due to an action on 
the inhibitory centres in the heart or on the peripheral vagi. Ringer, 
on the other hand, has proved that it slows the beat of the ventricles 
in the frog when they are separated from these centres, and believes 
that the drug acts directly on the motor centres of the heart-muscle 
and the muscle itself. In man the drug does not slow the pulse, but 
quickens it very markedly, often as much as forty to fifty beats per 
minute. The rise of arterial pressure seen in the animal is often 
replaced by a fall of pressure in man, and, though the pulse in ani- 
mals is generally made stronger from its use, in man it is generally 
weaker. 

Temperature. — Jaborandi lowers bodily temperature to a con- 
siderable degree, probably by the dilatation of the peripheral capil- 
laries and the profuse sweat which it produces. This fall is some- 
times preceded by a brief rise. 

Kidneys and Tissue-waste. — Upon the kidneys jaborandi acts 
very slightly or very strongly, according to the dose that is given. 
Large doses, which produce a profuse sweat, naturally decrease the 
urinary secretion, and small ones undoubtedly increase it. Upon the 
tissue-changes in the body under pilocarpine no researches have been 
made, but it is an undoubted fact that the excretion of urea is largely 
increased in disease under the influence of this drug. 

Eye. — Jaborandi contracts the pupil by acting peripherally on the 
nerves of the iris. 

Skin. — The amount of sweat caused by the drug in man may 
equal as much as a pint, and it is generally first acid, from the secre- 
tions of the sebaceous glands, then neutral, and finally alkaline. 
The sweating is not due to vasomotor palsy, but to stimulation of 
the ends of the nerves supplying the glands and of the sweat-glands 
themselves. Sometimes excessive salivary secretion supplants that 
of the skin. 

Pilocarpine increases the gastric, salivary, and lachrymal secre- 
tions, as well as that of the skin and kidneys. It also seems to have 
considerable influence over the secretion of milk. 

Therapeutics. — Jaborandi, or, better still, its alkaloid, pilocarpine, 
is of great value for the relief of dropsy of the renal type. In that 
due to cardiac disease it is generally too depressing, and the author 
knows of a case in which a fatal result followed its use under these 
circumstances. It may be used to abort an attack or paroxysm of 
malarial fever, but because of its depressant influence should never 
be employed in asthenic fevers, such as typhoid fever. In pleurisy with 
effusion it may be used, but more efficient remedies are elaterium, or 
salines given in concentrated form and at the proper time of the day. 



PILOCARPUS. 301 

(See Magnesium Sulphate and Dropsy.) Spaulding and De Schweinitz 
have both recommended very highly the use of pilocarpine hypoder- 
mically in the dose of T ^ to y^- grain (0.005-0.006) a clay for opacities 
of the vitreous humor of the eye. The fluid extract of jaborandi 
may be employed, but is apt to nauseate the patient. Diaphoresis 
should not be produced. Mitkowski has tried pilocarpine in catarrhal 
jaundice of a persistent type with great benefit, in the hypodermic 
dose of \ grain (0.01) every other day for three weeks. In urcemic 
poisoning pilocarpine is the most efficient and rapidly acting remedy 
that we have, and when used in Bright 's disease it is of value in sev- 
eral ways — first, by removing the strain on the kidneys ; second, by 
eliminating the ursemic poison ; and third, by decreasing the inflam- 
matory condition in the kidneys by lowering the blood-pressure, 
which, it will be remembered, is the more constant effect of the drug 
in man. Care should always be used in the use of the drug lest car- 
diac depression ensue, and alcohol or strychnine may often be used 
with advantage to guard against this accident. The drug in small 
doses certainly increases renal activity. The hypodermic dose as a 
renal stimulant should be about -^ to -^ of a grain (0.002-0.003). 
In some forms of profuse sweating, such as come on at night in gen- 
eral debility, pilocarpine, if given hypodermically or by the mouth 
about two hours before the sweat in the dose of -fa of a grain (0.003), 
is often useful even where atropine fails. Pilocarpine certainly has 
a decided effect in encouraging the growth of hair, and applied locally 
will often do good in partial baldness. If too much pilocarpine is 
used, it is apt to cause the development of small pustules about the 
hair-follicles. Bartholow recommends the following application for 
baldness : 

R— Extract, pilocarpi fluid f £j (32.0). 

Tincturse cantharidis f }fss (16.0). 

Liniment, saponis f ^jss (48.0). — M. 

The author has found the following prescription peculiarly effica- 
cious in falling of the hair : 

R — Extract, pilocarpi fluid. ........ f.^j (4.0). 

Tr. capsici f gj (32.0). 

Tr. cantharidis f^ss (16.0). 

01. ricini f 3J (4.0). 

Alcohol. . . , ; q. s. f Jiv (128.0).— M. 

S. — Apply with friction in spots to the scalp, night and morning. 

Clinical reports show that pilocarpine in small doses is a very good 
remedy in tobacco and alcoholic amblyopia. DaCosta, Salinger, and 
Barr have highly recommended the hypodermic injection of pilocar- 
pine in erysipelas as a preventive and curative measure in the early 
stages of this disease, and their reports are so encouraging as to war- 
rant a careful trial of the method. The proper dose is -J- grain (0.01) 
every three hours until free sweating ensues. After this is accom- 
plished the doses may be repeated every four or six hours. The 
author would fear that such active treatment might seriously affect 
the strength of the patient unless stimulants were also used. 



302 DRUGS. 

Antagonisms of Jaborandi. — Jaborandi is a physiological antidote 
to atropine and to agaricin. Four times the dose of pilocarpine must 
be used to equal a dose of atropine. 

Administration. — The dose of jaborandi is 40 grains (2.65), used 
in the form of the powdered leaves in infusion. The fluid extract 
{Extractum Pilocarpi Fluidum, U. S.) should be used in the dose of 
30 drops to 1 drachm (2.0-4.0). Pilocarpine is far superior to jabo- 
randi, in that it does not so often produce nausea and vomiting. It is 
used in the form of the hydrochlorate (Pilocarpine Hydrochloras, 
U. S.), in the dose of from J to J of a grain (0.008-0.03) hypoder- 
mically, or J to J of a grain (0.015-0.03) by the mouth. 

The preparations of the B. P. are — the extract (Extractum Jabo- 
randi), dose 2 to 10 grains (0.1-0.65); the infusion (Infusum Jabo- 
randi), dose 1 to 2 fluidounces (32.0-64.0); the tincture (Tinctura 
Jaborandi), dose J to J fluidounce (8.0-16.0); and the nitrate of pilo- 
carpine (Pilocarpine Nitras), dose ■£$ to J grain (0.003-0.03). 



PIPERAZINE. 

This is a substance, the chemical formula of which is C 4 H I0 N 2 , 
which has been recently introduced into medicine for the treating of 
the uric-acid diathesis. It is not stable, and when exposed to the air 
attracts water and carbonic acid. Aqueous solutions are decidedly 
alkaline, but do not have any distinct taste. 

Piperazine is peculiar in its power to dissolve uric acid, dissolving 
twelve times as much as will carbonate of lithium, while it is also 
entirely soluble in water, which lithium is not. When taken into the 
body the drug is partly oxidized and partly eliminated unchanged. 
Theoretically, piperazine, when taken into the body, forms with uric 
acid a urate of piperazine, which is soluble and readily eliminated. 
Experiments have been made to determine this point with very satis- 
factory results, but repeated clinical observation has shown that the 
administration of the drug causes an increase in the amount of urea 
in the urine with a decrease in the uric acid, indicating that under its 
influence oxidation is more complete. 

Therapeutics. — Piperazine is used for the purpose of preventing the 
formation of renal and vesical calculi in the uric-acid diathesis, and 
also in cases where the excess of uric acid in the urine tends to pro- 
duce irritation of the bladder. Similarly, its action has been found 
of value in treating vesical irritation due to this cause by washing out 
the bladder with a solution of piperazine of the strength of 1 per cent. 
Piperazine has also been injected into uric-acid deposits about the 
body or applied to the broken-down surfaces of these deposits in 1 
per cent, solution, but the author has not been favorably impressed 
with this method, and would advise against its use — first, because it 
does little if any good, and, second, because the method is painful 
and apt to cause sloughs by interfering with nutrition of the skin 
when already lacking in health. 



PITCH. 303 

The dose of piperazine is 15 grains (1.0) in twenty-four hours. It 
is best given by dissolving this amount of the drug in 1 pint (^ litre) 
of water, and directing the patient to take a wineglassful of the solu- 
tion frequently through the day. Owing to the effect upon the drug 
of exposure to air, it cannot be given in pill or powders, and should 
be freshly mixed each day. The writer has failed to obtain any 
results from the use of this drug in his practice. 

Stewart has noted, as untoward effects of full doses of piperazine, 
tremors, hallucinations, and clonic spasms. 



PISCIDIA BRYTHRINA. 

Piscidia Erythrina is a drug which is stated to possess marked nar- 
cotic and pain-relieving properties. It is sometimes called Jamaica 
dogwood. Its powers as a soporific and analgesic do not compare 
with those of opium, but it is stated to be devoid of the unpleasant 
after-effects of the latter drug. Further studies concerning its effects 
on the animal economy are needed. According to Dr. Isaac Ott and 
Dr. Nagle, the drug has little or no effect on the motor and sensory 
nerves, and its dominant effect on the circulation is to increase arterial 
pressure through stimulation of the vasomotor system. The indica- 
tions which have been met best by piscidia are dysmenorrhea due to 
irregular flow and spasm of the uterine cervix and fundus, to allay 
nervous irritability, and to relieve pain or insomnia due to pain. 

Administration. — The dose of the fluid extract of piscidia erythrina 
is \ to 2 drachms (2.0-8.0); of the solid extract, 2 to 10 grains (0.1- 
0.65). The alkaloid piscidine is not known to represent all the prop- 
erties of the drug, and is not used in medicine. 



PITCH. 

Pix is a resinous exudation derived from several species of pines, 
firs, and spruces, and is, in one of its forms, obtained by the evapora- 
tion of wood-tar. It is used for various purposes, according to its 
derivation. Burgundy Pitch (Pix Burgundica, U. S. and B. P.) is 
derived from Norway spruce, or Abies Excelsa, a plant of Europe and 
Asia. It softens and melts at the temperature of the body and is 
useful in plasters. In muscular rheumatism and in chronic bronchitis 
pitch is a mild and fairly useful local remedy. In the form of the 
plaster (Emplastrum Picis Burgundico?, U. S. and B. P.) and in the 
form of warming plaster (Emplastrum Picis Cantharidatum, U. S.) it 
is employed for the relief of deep-seated sprains and bruises, and acts 
as a mild counter-irritant, which may blister a tender skin. Canada 
Pitch (Pix Canadensis, B. P.) is obtained from the hemlock spruce 
of Canada and the United States, and is used for the same purposes 
as Burgundy pitch. The Canada-pitch plaster (Emplastrum Picis 
Canadensis) is employed for the same conditions as the plaster of 
Burgundy pitch. 



304 DRUGS. 

Tar. 

Under the name of Pix Liquida, U. S. and B. P.. or Tar, we have 
an empyreumatic oleoresin obtained by destructive distillation from 
Pinus Palustris and other varieties of pine. It is a thick, dark oil, 
slightly soluble in water and soluble in alcohol, oils, and solutions of 
potassa and soda. By distillation of tar we obtain oil of tar {Oleum 
Picis Liquidce, U. S.), which is sometimes used by inhalations from 
an atomizer in bronchitis, but is not a particularly useful application. 
It should be diluted with some other oil or with fluid cosmoline. Tar 
itself is used in subacute and chronic bronchitis in 2-grain (0.1) pills 
and as a remedy for g astro-intestinal catarrh. Externally, it is used 
in psoi*iasis and other skin diseases needing stimulation. In obstinate 
diarrhoea Wood has highly recommended a mixture of tar made as 
follows : Add a pint of tar to a gallon of lime-water, and allow this 
solution to stand one week, stirring it every few hours. Decant the 
clear liquid and percolate it through powdered wild-cherry bark, 
allowing 1 ounce of the bark to be present for each pint passed 
through it. The dose is a Avineglassful (30.0). 

In chronic bronchitis tar-water is largely used, as a popular rem- 
edy, in Europe and England. Tar-water is made by shaking 1 part 
of tar with 4 parts of water several times during twenty-four hours, 
decanting, and filtering. The dose is from 1 to 2 pints (J-l litre) 
a day as a drink. It at first increases the expectoration, but finally 
decreases it. 

Syrup of Tar (Syrupus Picis Liquidce, U. S.) is simply sweet- 
ened tar-water. 

In skin diseases of the dry, scaly sort, such as psoriasis, tar oint- 
ment ( Unguentum Picis Liquids, TJ. S. and B~ P.), equal parts of 
tar and suet, is very useful if frequently applied, or the following 
may be used : 

g --|S"S Cipitat } -3vj(24.0). 

Scorns viridis | aa gij (64.0). 

Pulv. cretse giv (16.0). 

If the skin is tender, this prescription should be diluted with lard. 
Sometimes children will suffer from a persistent dry chronic eczema 
which resists all treatment ; the following may then be employed with 
advantage : 

R.— Picis liquid 3ss (2.0). 

Sulphur, praecip £ss (2.0). 

Unguent, zinc, oxidi ^j (32.0). 

S. — Apply night and morning. 

Tar should not be used on the face, as it will stain the skin. 

Wine of Tar ( Vinum Picis) is made by adding together tar 1 
pint, glycerin, white wine, and honey, of each J a pint, dilute acetic 
acid 1 ounce, and 3 quarts of boiling water, and shaking constantly 
at a temperature of 160° F. for several hours. It is then set aside 



POMEGRANATE. 305 

to stand for some days and repeatedly filtered or strained through 
muslin. The dose is 1 to 4 ounces (32. 0-128.0). It may be used 
instead of tar-water or tar-syrup. 



PODOPHYLLUM. 

Podophyllum, TJ. S. (Podophylli Rhizoma, B. P.), May Apple or 
Mandrake, is the rhizome and small roots of Podophyllum Peltatum, 
a plant of the United States and Canada. Podophyllum contains a 
resin, podophyllin. 

Therapeutics. — Podophyllum is the slowest-acting purge in the 
Pharmacopoeia. In small doses it is laxative, but is purgative and 
almost drastic in larger amounts. In overdose it may produce gas- 
tro-enteritis. The drug particularly excites the flow of bile, and is 
used as a cholagogue. It is best given when the stools are dark in 
color, calomel being indicated when they are light. In children one 
or two months old who have hard, stony stools podophyllin is the best 
remedy. The dose should be given by dissolving a grain of the resin 
in a drachm of alcohol and using 2 drops of this on sugar once or 
twice a day. In children who suffer from diarrhoea in which the 
passages consist almost entirely of water, which have a peculiar 
musty smell or a mouse odor, podophyllin in the dose of -fa to fa of 
a grain (0.001-0.0012) is of service, seeming to control the passages 
and make them normal. This treatment will often succeed when all 
else fails. This statement is also true in regard to the chronic diar- 
rhoeas of adults, though the drug should be given in somewhat larger 
amounts in such cases. Podophyllin will also check vomiting in these 
doses in some instances, provided that the stomach is depressed and 
the liver is torpid. It should not be employed if the vomiting is due 
to irritation or inflammation. 

Administration. — Podophyllum is used in the form of the extract 
{Extr actum Podophylli, TJ. S.), dose 1 to 5 grains (0.05-0.35); the 
fluid extract (Extraction Podophylli Fluidum, TJ. S.), dose 2 to 20 
drops (0.1-1.3); and, more commonly than all, as the Resina Podo- 
phylli, TJ. S. and B. P., or podophyllin, which is the best prepara- 
tion. The dose of this preparation is from -fa to fa of a grain (0.003- 
0.006) as a laxative, and from fa to J a grain (0.006-0.03) as a purge. 
The tincture of the resin (Tinctura Podophylli, B. P.) is given in 
the dose of 15 minims to 1 drachm (1.0-4.0). 



POMEGRANATE. 

Although G-ranatum ( TJ. S.) is official, it is almost never used in 
America in its crude form. It contains an alkaloid known as pelle- 
tierine, this alkaloid being a colorless liquid, soluble in 20 parts of 
water and readily miscible with ether, chloroform, and alcohol. When 
acids are added to it, it forms crystalline salts, of which four are used 
— namely, the tannate, the sulphate, the hydrobromate, and the hydro- 

20 



306 DRUGS. 

chloride. The first is most commonly employed, and is a yellowish 
powder possessing an astringent taste. It is soluble in 700 parts of 
water and 80 of alcohol. Its physiological action needs further inves- 
tigation, but it seems probable that the drug in poisonous amounts 
paralyzes the peripheral ends of the motor nerves in a manner closely 
resembling the action of curare. 

Therapeutics. — Originally, pomegranate was largely used in the 
form of the rind of the fruit in decoction as a vegetable astringent, 
but this practice has ceased because of its disagreeable taste and effect 
upon the stomach. The ailments which were supposed to indicate its 
employment were serous diarrhoea and profuse sweats. In some trop- 
ical countries the bark of the root is used as a vermifuge, and is very 
efficient in removing the tape-worm. It is said that the bark of the 
root of the wild shrub is much more efficacious than that of the cul- 
tivated and more handsome plant. To be efficacious the dose of the 
decoction of the bark must be large. The drug is prepared by soak- 
ing 2 ounces (64.0) of the bark in 2 pints (1 litre) of water for 
twenty-four hours and then boiling down to a pint (J litre). A wine- 
glassful (32.0) of this is the dose which is generally given, and it may 
be repeated every hour until the whole amount is taken. The objec- 
tion to this line of treatment is that it is unnecessarily severe, often 
purging and vomiting the patient excessively. The nausea produced 
is often great. Should purging fail to appear, it is necessary to give 
castor oil or other purge to dislodge the worm, and it is always neces- 
sary to starve the patient for twelve hours before the remedy is tried. 

The dose of pelletierine is 3 to 5 grains (0.25-0.35), and the tan- 
nate is the salt always employed. Practically, the only pelletierine 
used is that of Tanret, and his preparation is a syrupy solution in 
each bottle of which is one dose of the drug. 

As large doses as 20 grains (1-3) of pelletierine have been used, 
but as very serious paralytic symptoms have ensued after the inges- 
tion of 5 grains by a susceptible woman, not more than this amount 
should be given. When pelletierine is used it should always be fol- 
lowed in two hours by a purge. Those who have used it most place 
great reliance on it. 

The B. P. contains one official preparation of pomegranate — 
namely, the Decoctum G-ranati Badicis, the dose of which is 1 to 2 
fluidounces (32.0-64.0). 



PRUNUS VIRGINIANA. 

Prunus Virginiana, U. S. — Wild Cherry, as it is incorrectly- called 
— is the bark of Prunus Serotina, a large tree of the United States 
and Canada. It contains two substances, known as emulsin and 
amygdalin, which when they come together in water form hydro- 
cyanic acid. 

Therapeutics. — Wild-cherry bark is largely used as a domestic tonic, 
and in the form of a syrup as a vehicle for cough mixtures. 
. It has been supposed that the hydrocyanic acid present allays the 



QUASSIA. 307 

cough, but this is doubtful, as the acid is very fleeting in its effect and 
present in very small quantity. 

Administration. — As a tonic it is used in the form of the infusion 
(Infusum Pruni Virginians, TJ. S.), dose J to 1 ounce (16.0-32.0 
and the fluid extract (Extr actum Pruni Virginiano? Fluidum, TJ. S. 
dose 30 drops to 1 drachm (2.0-4.0). The syrup (Syrupus Pruni 
Virginiance, TJ. S.) is given in the dose of 1 to 4 drachms (4.0-16.0). 



PYROGALLOL. 

Pyrogallol, TJ. S., sometimes called Pyrogallic Acid, is obtained 
by dry distillation of gallic acid, and should be kept in dark well- 
stoppered bottles. It occurs in light white scales or crystals, has no 
odor, but a bitter taste. If exposed to the light, it becomes dark. 
It is soluble in 2J parts of water, and readily so in ether and alcohol. 

Therapeutics. — Pyrogallol is used in parasitic skin diseases, in 
ointment, in the strength of 30 to 100 grains (2.0-7.0) to the ounce 
(32.0). The stronger ointments exercise a mild caustic effect. It 
may be employed in place of chrysarobin in psoriasis. Unfortu- 
nately, it stains the skin a deep brown. 



PYOKTANIN. 
(See Methyl Blue.) 

QUASSIA. 

Quassia, TJ. S. (Quassice Lignum, B. P.), is the wood of Picrama 
Excelsa, a large tree of Jamaica and other islands of the West Indian 
group. It contains an active principle, named quassin, which is 
intensely bitter and an irritant to mucous membranes. Quassia is a 
simple bitter tonic which has been used very largely in domestic 
medicine and by the medical profession. It is very efficient as a 
tonic, is supposed to be particularly useful in the anorexia follow- 
ing malarial fevers, and has even been thought to possess antiperiodic 
power. In simple dyspepsia with eructations after meals, not due to 
gastritis, it is very serviceable. 

In the treatment of seat-worms (Oxyuris vermicular is), or thread- 
worms, as they are often called, injections of the infusion of quassia 
are the most efficacious and useful remedial measures we possess, and 
are also very harmless to the patient. The bowel should be well 
washed out by soap and water, and J pint to a pint of an infusion, made 
by adding 1 or 2 ounces (32.0-64.0) of quassia chips to a pint (J litre) 
of water, should be injected and retained for some minutes. A few 
such injections will invariably kill the parasites, provided the bowel 
is first well washed out with soap and water and enough fluid be 
injected to reach high up into the rectum. 



308 DRUGS. 

Administration. — The tincture (Tinctura Quassice, U. S. and B. P.) 
is given in the dose of J a drachm to 1 drachm (2.0-4.0), the fluid 
extract {Extr actum Quassice Fluidum, U. S.) J a drachm (2.0), and 
the extract {Extractum Quassice, U. S. and B. P.) 1 to 3 grains 
(0.05-0.15). The infusion (Infusum Quassice, B. P.) is given in the 
dose of J to 2 ounces (16.0-64.0), and is made by macerating 1 
drachm (4.0) of quassia with 10 ounces (320.0) of water, and allow- 
ing it to stand twenty-four hours or more. 



QUERCUS ALBA. 

Quercus Alba, U. S., or White Oak, in infusion is used as an 
astringent injection in gonorrhoea and vaginitis in the female, where 
a large amount of fluid is necessarily employed. It is also used in 
prolapse of the rectum, in hemorrhoids, in leucorrhcea, and as a gargle 
in sore throat. It stains the clothing very slightly. 

Quercus Tinctoria is equally efficient, but is seldom used, because 
it stains the clothes very badly. Either may be used in infusion of 
the strength of 1 ounce to the pint (32.0 : ^ litre). In the form of 
the powdered bark it is often used as an astringent poultice to freely 
running sores to check the discharge. JDecoctum Quercus is official 
in the B. P. 

RESIN, or ROSIN. 

Besina, U. S. and B. P., is Resin or Rosin, the mass left after 
the distillation of turpentine, and enters largely into plasters, cerates, 
and similar preparations. Its burning fumes when inhaled are said 
to be of value in cases of chronic bronchitis. Ceratum Resince, U. S., 
is used in chilblains and superficial scalds, and Emplastrum Besince, 
U. S. and B. P., is adhesive plaster. TJnguentum Besince is a B. P. 
preparation used for the same purposes as the plaster or cerate. 



RESORCIN. 

Resorcin, U. S., is the meta-com-pound of the group of which 
hydrochinone is the para- and pyrocatechin the ortho-, and occurs in 
clear crystals of a slightly reddish hue. It is quite soluble in water, 
alcohol, and ether. 

Physiological Action. — Resorcin is an irritant to mucous mem- 
branes, and when taken internally in poisonous doses causes deafness, 
giddiness, salivation, profuse sweat, unconsciousness, and clonic con- 
vulsions. The heart of the dog under its influence is at first slowed 
by vagal stimulation, and then becomes very rapid from vagal palsy. 

Therapeutics. — Resorcin has been found of service as a remedy for 
whooping cough, given in the dose of 10 drops (0.65) of a 2 per cent, 
solution or used in a spray of the same strength, the latter being the 
better method of using the drug. 



RHUBARB. 309 

Resorcin has also been employed in a spray in 2 per cent, solution 
in hay fever with remarkably good effects. It has been used as an 
antipyretic, but is not serviceable and has little power over strong 
fevers. 

The chief use of resorcin is in skin affections of a subacute or 
chronic character, such as eczema with much induration, and in psori- 
asis. In these states an ointment of the following character, well 
applied, is of service : 

R — Eesorcin 3J (4.0). 

Zinci oxidi £j (4.0). 

Ung. aquse rosse £x (40.0). — M. 

S. — Apply to the part affected twice a day. 

After mixing the ointment heat it until the resorcin crystals melt, 
to prevent any irritation of the skin. 

Within the last few years resorcin has been employed with good 
results in the treatment of gastric ulcer in the dose of 2 to 4 grains 
(0.1-0.2) before each meal in pill or capsule. It is supposed to act 
by reason of its analgesic, antiseptic, and haemostatic power. 



RHIGOLENE. 

This is a product of petroleum obtained by repeated redistillation 
until the liquid resulting from this process boils at 64.4° F. It 
evaporates more rapidly than any other known liquid, except cymo- 
gene, which boils at 32° F., and is used in a spray for the production 
of localized numbness or freezing before minor painful operations, 
such as the use of the actual cautery. 



RHUBARB. 

Rheum, TJ. S. (Rheum Radix, P. B.), is the root of Rheum Offici- 
nale, a plant of Thibet, but which is cultivated in America and else- 
where. It is also derived from China, and this variety is known as 
Chinese rhubarb. Several alkaloids are contained in it, all of which 
are unimportant and never used alone, except chrysophanic acid. 

Physiological Action. — According to the studies of Prevost and 
Binet, rhubarb acts inconstantly upon the flow of bile, sometimes 
increasing it, sometimes having no effect, but, on the other hand, 
according to those of Rutherford and Yignal, it never fails to stimu- 
late biliary secretion. Owing to the astringent properties possessed 
by rhubarb, it does not purge excessively, and improves the appetite, 
digestion, and intestinal tone. 

Therapeutics. — Whenever it is desired simply to unload the bowels 
without affecting the general system rhubarb may be employed. In 
other words, it is useful in simple constipation. In children a state 
is very commonly seen in which constipation is replaced by diarrhoea 
if any ordinary laxative is employed, and in these instances rhubarb 
is the best remedy, as it is astringent and prevents any after-effects 



310 DRUGS. 

beyond those produced by the dose. In the summer diarrhoea of 
children, where the stools are green, rhubarb is often used to empty 
the bowels of fermentative products before direct treatment is insti- 
tuted. Rhubarb, because of its chrysophan, may stain alkaline urine 
carmine or acid urine yellow. 

Administration. — The preparations of rhubarb are unnecessarily 
numerous. Rhubarb itself may be given in the dose of 20 grains 
(1.3) in powder, and small pieces of the root are habitually chewed 
by some persons for the relief of constipation. Extraction Rhei, 
U. S. and B. P., is given in the dose of 5 to 10 grains (0.35-0.65) 
in pills. Pilulce Rhei, U. S., of which each pill contains 3 grains 
(0.25) of rhubarb, is given in the dose of one to three pills (0.05-0.25) ; 
and PiluloB Rhei Compositus, U. S. and B. P., which contain 2 grains 
(0.1) of rhubarb and 1J (0.09) of aloes, are given in the same dose. Pul- 
vis Rhei Compositus, U. S. and B. P., contains rhubarb, magnesia, 
and ginger, and is given in the dose of 20 to 40 grains (1.3-2.6); Ex- 
tractum Rhei Fluidum, U. S., is given in the dose of 20 to 30 minims 
(1.3-2.0). Syrupus Rhei, U. S. and B. P., is given in the dose of 
1 drachm (4.0) to a babe, and 4 drachms (16.0) to an adult, although 
rarely used for older persons. Syrupus Rhei Aromaticus, U. S., is 
given in the same dose and to the same class of cases. Tinctura 
Rhei, U. S. and B. P., is used in the dose of 1 to 2 drachms (4.0- 
8.0), and Vinum Rhei, B P., in the dose of 1 to 4 drachms (4.0-16.0). 
Tinctura Rhei Aromatica, U. S., is used in the dose of J to 1 drachm 
(2.0-4.0), and Tinctura Rhei Dulcis, U. S., 2 to 3 drachms (8.0-12.0). 
The aromatic spirit is commonly employed for children, and the com- 
pound pills for adults. Infusum Rhei, B. P., is given in the dose 
of 1 to 2 ounces (32.0-64.0), and Mistura Rhei et Sodoe, U. S., in 
the dose of 2 drachms to 3 ounces (8.0-96.0). 



RHUS AROMATICA. 

Sweet Sumac is unofficial, but has been so largely used of late 
that it deserves notice. In hematuria, monorrhagia, diabetes insip- 
idus, and in urinary incontinence in children depending upon vesical 
atony it has been highly praised. In the latter affection a sufficient 
amount of experience has been acquired to show that it really is of 
benefit. Rhus Aromatica should be used in the form of the fluid 
extract, derived from the bark of the roots according to the general 
directions in the Pharmacopoeia for making fluid extracts. The 
dose as a remedy for urinary incontinence is 15 drops (1.0) of this 
preparation. Adults may take from 15 to 60 drops (1.0-4.0). The 
drug is best given with glycerin and water. 



RHUS GLABRA. 

Rhus Glabra, U. S., Smooth Sumac, is the fruit of Rhus Glabra, 
and contains tannic and malic acids as its chief constituents of me- 



BUBUS ID^EUS. 311 

dicinal value. In the fluid extract (Extr actum Rhois Glabra? 
Fluidum, U. S.) we have an official preparation which is very 
efficient as a gargle for sore throat when diluted with glycerin and 
water or prepared according to the formula given under Chlorate 
of Potassium. 

ROCHELLE SALT. 

Potassii et Sodii Tartras, U. S. (Soda Tartar ata, B. P.), has been 
used as a saline cathartic in the dose of J an ounce (16.0), and is 
preferred by many patients to Epsom salt because its taste is not so 
disagreeable. It is, however, more irritating. Rochelle salt is the 
purgative constituent of Seidlitz powder. 



ROSA CBNTIFOLIA. 

Rosa Centifolia, U. S. (Rosa? Centifolia Petala, B. P.), Pale Rose, 
possesses almost no medicinal value, but is mentioned because its 
official preparations are largely used in practice. 

Aqua Rosce, U. S. and B. P., is used as a diluent or solvent for 
preparations, such as astringents, which are to be employed locally, 
as in injections for gonorrhoea. It may also be used internally for 
these purposes. Unguentum Aquce Rosas, U. S., is "cold cream," 
and is largely used as an emollient application to small burns, sores, 
cuts, scratches, and chapped hands and lips. It is much improved 
if a little glycerin and benzoic acid are added to keep it sweet in 
warm weather. 



ROSA GALLICA. 

Rosa G-allica, U. S. (Rosas G-allicas JPetala, B. P.), Red Rose, con- 
tains more gallic and tannic acids than pale rose, and is astringent. 
From it are prepared the Extr actum Rosas Fluidum, U. S., dose 5 
drops to 2 drachms (0.35-8.0), used to flavor other extracts, and the 
Confectio Rosee, U. S. and B. P., which is used as a basis for pills. 
Mel Rosas, U. S., or honey of rose, is employed as a local application 
or as a vehicle for gargles, and the Syrupus Rosas, U. S. and B. P., 
dose 1 to 2 drachms (4.0-8.0), as a flavoring substance. The acid 
infusion (Infusum Rosas Acidum, B. P.) is given in the dose of 1 to 
2 ounces (32.0-64.0). 



RUBUS ID^IUS, or RASPBERRY. 

Rubus Idceus, U. S., or Raspberry, is used for the preparation of a 
syrup (Syrupus Rubi Idosi, U. S.) which is employed very largely as 
an elegant vehicle or flavoring mixture. The leaves are often used 
in domestic medicine in a decoction or infusion for the cure of diar- 
rhoea when an astringent i s needed. 



312 DRUGS. 



RUE. 



Ruta G-raveolens is the source from which we derive the Oil of Rue 
[Oleum Ruta, B. P.). 

Physiological Action. — Locally applied, rue is an irritant, produ- 
cing vesication, and if taken internally in large amount gastro-enteritis, 
which may be most severe. It is eliminated by the lungs, kidneys, 
and skin, and its odor is easily noticed in all these secretions. If the 
dose be poisonous, vomiting, great pain in the belly, and epileptiform 
convulsions come on, but death has rarely occurred. 

Therapeutics. — Rue has been used as an abortifacient, but with 
great danger to the mother. Its action is most uncertain even when 
poisonous doses are employed. It has been given in colic as a car- 
minative, and seems to be really valuable in atonic menorrliagia and 
metrorrhagia. 

Given in capsule, oil of rue has been employed for the removal 
of lumbricoid or round-tvorms, but ought not to be so used. The 
dose of the oil is 8 to 6 drops (0.25-0.40). 



SACCHARIN. 

Saccharin is a compound first prepared by Fahlberg under the 
direction of Professor Remsen of Johns Hopkins University. It is 
a remarkably sweet substance, two hundred and twenty times stronger 
than sugar in sweetening power, and is used largely to sweeten glucose 
and in confections. It escapes from the body unchanged, and has 
been used in place of sugar in cases of diabetes and gout to sweeten 
coffee, food, or medicine. 

The dose is indefinite, but it is to be noted that a very few grains 
will sweeten a very large bulk of material. 

Physiological Action. — Upon the circulation and similar vital func- 
tions saccharin has no effect, but Plugge has proved it to retard the 
action of all the digestive ferments, and to be in consequence harmful 
to diabetics whose digestion is impaired. 



SALICYLATE OP BISMUTH. 

Salicylate of Bismuth is a white, soft powder, insoluble in water, 
alcohol, ether, and chloroform, but soluble in acids. It is largely 
used by some practitioners, particularly on the European continent, 
as an intestinal antiseptic in cases where, in the presence of gastro- 
intestinal catarrh, fermentation or putrefaction is thought to be pres- 
ent in the bowel. It is to be given in powder, or, better still, in cap- 
sules, in the dose of 3 to 15 grains (0.25-1.0). 



SALICYLATE OP MERCURY. 

Salicylate of Mercury is a drug which has come into quite general 
use since the introduction of the hypodermic method of administer- 



SALICYLIC ACID. . 313 

ing mercury in syphilis. It is to be suspended in paraffin oil in the 
proportion of 22 grains (1.5) of the salicylate of mercury to 3 
drachms (12.0) of the oil, and before it is used the bottle must be 
well shaken in order that the insoluble mercury may not remain at 
the bottom. It is of great importance that the needle and syringe 
shall be thoroughly cleansed after each injection, as the insoluble 
drug readily clogs the opening of the instrument. At first 1 minim 
(0.05) of the mixture just named should be injected deeply into the 
gluteal region every fourth day, and this may be increased to every 
second day if no systemic evidences of the action of the drug appear. 



SALICYLIC ACID. 

Salicylic Acid {Acidum Salicylieum, U. S. and B. P.) occurs in 
fine white crystals or in fine white powder. It has a sweet yet acrid 
taste, and is derived from carbolic acid by treating it with caustic 
soda and carbonic acid at a moderate heat. Sometimes it is derived 
from plants in which it exists in combination ; and this source is the 
best, although the artificial acid is chiefly used. If the crystals are 
pinkish in hue, the acid should not be used, as it is probably impure. 
It is soluble in 500 parts of water and 4 parts of alcohol. 

Physiological Action. — On mucous membranes salicylic acid acts 
as an irritant. (See Poisoning.) 

Nervous System. — Upon the nervous system salicylic acid exerts 
comparatively slight effects in medicinal doses, causing buzzing in the 
ears, decrease of the reflexes, and finally producing, in overdose, epi- 
leptiform convulsions by an action on the brain. 

Circulation. — Upon the circulation the effects of salicylic acid 
are not very marked in medicinal dose. It undoubtedly has a depress- 
ant rather than a stimulant effect, but the depression is very slight. 
It is sufficient, however, to make the use of the drug in cases of feeble 
circulation worthy of thought and care. 

Respiration. — Salicylic acid stimulates the pulmonary vagi and 
respiratory centre, but if the dose be poisonous death is due to respi- 
ratory failure. 

Temperature. — The effect of salicylic acid on temperature has 
been studied by the author with a good deal of care. The drug acts 
as a distinct antipyretic upon fevered states, and is a slight depress- 
ant of normal bodily heat. The studies of Gedl, Furbringer, and 
See also show this, and those of Danewsky point to it. In the experi- 
ments of North upon man, after and during exercise, the antipyretic 
effects were marked. According to the author's studies, the drug 
lowers fever by diminishing heat-production and increasing heat-dis- 
sipation, but this is by no means positively decided as a fact. 

Absorption and Elimination. — Salicylic acid is absorbed from 
the stomach as a salicylate of sodium, and so circulates in the blood. 
It is eliminated by the kidneys and by all the secretions. In the 
urine it appears as salicyluric acid. The urine after large doses is 
dark olive-green, and the change in color is due to the presence of 



314 DRUGS. 

indican and pyrocatechin, which are formed by the action of the pan- 
creatic juices upon the drug in the intestine. The presence of sali- 
cyluric acid in the urine is to be discovered by the addition of a solu- 
tion of the chloride of iron to that fluid, which causes the appearance 
of a violet color. 

Poisoning. — Salicylic acid when taken in excessive dose causes 
profuse sweating, roaring in the ears, dimness of vision, headache, 
partial or total deafness, and a decided fall in temperature. The 
pulse becomes weak and relaxed, and finally ptosis, strabismus, and 
general paralysis ensue. The urine and faeces are passed involun- 
tarily, and the urine is olive-green in color. The respirations at first 
are quickened and deepened, but finally become shallow and feeble, 
death ensuing from respiratory failure. 

If the dose is sufficiently large, the blood is involved and the cor- 
puscles rapidly break down. 

Therapeutics. — Salicylic acid, owing to its close resemblance to 
quinine, was first introduced as an antiperiodic and antipyretic, but 
soon was found to be of an inferior value in these states and of super- 
lative value in rheumatism. At present it is rarely if ever used for 
either of the former purposes, but is largely employed as a standard 
remedy for the latter trouble. 

The value of salicylic acid in rheumatism limits itself solely to 
the relief of pain and the cure of the malady without preventing the 
complications incident to its course. That is to say, the changes in 
the joints or heart in rheumatism are only of less frequency after the 
use of salicylic acid because the drug shortens the disease, and not 
because it prevents these changes by a direct influence ; this is also 
true of rheumatic hyperpyrexia, where salicylic acid is of service 
in shortening the attack, though it often fails to control the tempera- 
ture to any great extent. In acute rheumatism 15 to 20 grains (1.0- 
1.3) should be given every four hours until marked physiological 
symptoms occur. It is to be remembered, however, that in many 
cases the salicylates are of no value whatever, merely producing 
sweats and headaches, and it is also worthy of note that nothing else 
does these cases much good, as they seem bound to run a given course 
before the patient recovers. If a cure does take place, relapses are 
very common indeed, and the drug should always be continued for 
several days after all symptoms cease. In gonorrhoeal rheumatism 
salicylic acid is of little value until the gonorrhoea is cured, when 
the rheumatism also ceases, whether we give salicylates or not. In 
rheumatoid arthritis it is entirely valueless, and the same statement 
is true in regard to gout. In subacute rheumatism citrate of potas- 
sium and sodium may be used in place of salicylic acid in the dose 
of 30 to 60 grains (2.0-4.0), and these salts are to be taken just 
before going to bed. In lumbago, sciatica, and similar states salicylic 
acid is a very useful remedy. While it is not as good as antipyrine 
in neuralgia, it is of great service in the migraine of rheumatic per- 
sons, often entirely curing the disease. Haig has proved that the 
salicylic compounds all aid in the excretion of uric acid, and thinks 
they relieve rheumatism in this manner. 



SALICYLIC ACID. 315 

Salicylic acid has been largely used for the removal of pleural effu- 
sion with great success if the effusion be serous. Dock believes that 
the duration of treatment is less with the salicylates than by the use 
of diuretics, alteratives, or purgatives. The dose should be from 1 
to 2 drachms (4.0-8.0) daily. Doses larger than this are not neces- 
sary. How salicylic acid does good in pleural effusion we do not 
know, for its diuretic properties are not sufficiently great to drain 
away the liquid. 

In quinsy or true tonsillitis the drug is a specific, particularly when 
rheumatism is the cause. It will generally prevent suppuration, shorten 
the attack, and relieve the pain and swelling. The doses should be 
small, say 3 grains (0.25) at each dose, and given hourly. In stomatitis, 
after the blisters have broken, the burning and pain are often intense, 
and a mouth-wash of salicylic acid in the proportion of 1 to 250 of 
water is useful. 

Ringer recommends the use of the following salve in pruritus of 
the anus and vulva : 

R — Acid, salicylic gij (8.0). 

01. theobromse ^v (20.0). 

Cetacese £iij (12.0). 

01. myristicee f^iss (6.0). — M. 

In the treatment of corns there is probably no better application 
than lint soaked in a solution of salicylic acid, or the use of the fol- 
lowing formula : 

R. — Acid, salicylic. . gr. xxx (2.0). 

Ext. cannab. indicse . . . . gr. v. (0.35). 

Collodii f^ss (16.0).— M. 

S. — Apply with a brush until a good coat is formed. 

A useful salve for the soreness following horseback riding is one 
composed as follows : 

R. — Acid, salicyl gr. x. (0.65). 

Adip. benzoinat £j (32.0).— M. 

S. — Apply to the sore part. 

A solution of salicylate of sodium or of bicarbonate of sodium, 
applied on lint to inflamed rheumatic joints, often gives great relief. 
Smearing an ointment of salicylic acid over the joints not only pro- 
duces good effects locally, but by absorption of the drug influences 
the disease. (See Rheumatism, Part IV.) 

In gastric dilatation or catarrh, where vomiting occurs and the 
matters vomited contain sarcinm, salicylic acid will be found of ser- 
vice, and Bartholow thinks it of value in paroxysmal gastralgia. In 
adults suffering from ascaris lumbricoides, or round-worms, salicylic 
acid may be used in the dose of 8 grains (0.6) every hour till 40 
grains (2.65) are taken. For thread- or seat-worms the following 
injection will be found of service: 

R —Acid, salicylic ^ss (2.0). 

Sodii borat ^ss (2.0). 

Aquae . . . Oj (500.0).— M. _ 

S. — Warm, and inject into the bowels. For a child reduce this one-half in all its 
parts. i 



316 DRUGS. 

In bromidrosis of the feet (excessive sweating with foetor) salicylic 
acid may be dusted over the parts, or the following powder used : 

R — A cidi salicylic. \ __ - , 1fln , ' 

Pulv. ainyl. } • • • • ' aa gss (16.0).-M. 

S. — Apply to the feet. 

In eczema of the face and hands, where the eczema is of the wet or 
weeping variety, salicylic acid, locally applied, is often of great service. 

R. — Acidi salicylic gr. v vel x (0.3-0.65). 

Pulv. amyli ^ij (8.0). 

Pulv. zinci oxid '^ij (8.0). 

Petrolati 'Jss (16.0).— M. 

S. — Apply locally. 

If the eczematous process is subacute and needs stimulation, the 
salicylic acid may be increased to 20 or 30 grains (1.3-2.0). 

Antiseptic Use. — Salicylic acid is employed as an antiseptic in the 
treatment of wounds, as a local remedy, and as a dressing, but should 
not be applied over too large an area, as it may be absorbed and pro- 
duce constitutional symptoms. As an application to small burns a 
mixture of 1 drachm (4.0) of salicylic acid to 8 ounces (256.0) of 
olive oil is of service. 

In the treatment of soft chancres and venereal sores salicylic acid 
has been largely used by some practitioners either as a salve or as a 
dusting-powder, as follows : 

R. — Acid, salicylic gr. xx (1.3). 

Alcohol gtt. xlv (3.0). 

Adipis benzoinat ^ij (64.0). — M. 

R. — Acid, salicylic gr. xv (1.0). 

Pulv. amyli vel cretse ^ij (8.0). — M. 

Salicylic acid may be added to urine to prevent decomposition, but 
will sometimes cause the tests for sugar to appear. Patients taking 
salicylic acid often notice that the urine is odorless after standing, and 
that it will remain fresh for many days. 

Untoward Effects. — Salicylic acid, as already stated, may produce 
headache and roaring sounds in the ears. In persons with middle-ear 
disease it is contraindicated unless urgently called for, as it often 
makes the deafness permanently worse. Sometimes erythema or acne 
follows its employment, and blindness and retinal hemorrhages have 
been found to occur. Striimpell asserts that delirium of an active 
character sometimes appears after full doses of salicylic acid, which 
delirium is usually happy in its type, and seen most commonly in 
young girls. It would be impossible to enuumerate all the untoward 
effects which have been noted, but it is worthy of remark that very 
few deaths have taken place. 1 Binz thinks that full doses of sali- 
cylic acid may produce abortion in women who already have a tend- 
ency to abort, and Vineberg thinks that menorrhagia and metror- 
rhagia are caused. 

Administration. — Salicylic acid has a nauseous, disagreeable taste 

1 See author's essay on Antipyretics. 



SALOL. 317 

and is irritant to the stomach. It should be given in a solution of 
glycerin and water, or its taste may be covered by the use of syrup 
of bitter orange-peel or syrup of ginger. The following formulae may 
be used : 

R. — Acid, salicylic ^ij (8.0;. 

Tinct. lavandulse comp f^iv (16.0). 

Glycerini f§ss (16.0). 

Aquse • q. s. ad f^viij (256.0) — M. 

S. — A tablespoonful (16.0) every two hours. 

Or, 

R.— Acid, salicylic ^ij (8.0). 

Glycerini fjss (16.0). 

Syrup, aurantii f^iv (128.0). 

Aquee q. s. ad f§viij (256.0). — M. 

S. — A tablespoonful (16.0) every two hours. 

Salicylic acid may be used in pill or capsule, but is irritant to the 
stomach in so concentrated a form ; it must be taken with much 
water, and should follow rather than precede meals. Salicylic-acid 
ointment ( Unguentum Acidi Salicylici, B. P.) is a useful preparation 
for external application in chronic, deep-seated skin diseases. 

If buzzing in the ears produced by this acid is annoying, bromide 
of sodium in the dose of 20 grains (1-3) will generally give relief. 

Salicylate of Methyl. 

(See GrAULTHERIA.) 

Salicylate of Sodium. 

Salicylate of Sodium (Sodii Salicylas, U. S. and B. P.) is a less 
irritant and somewhat less disagreeable preparation than salicylic 
acid. Its internal action, use, and doses are the same as those of the 
acid. It maybe given by dissolving it in milk, and then adding ren- 
net to produce a curd, which covers the taste and protects the stomach. 

Other salicylates are largely used by some persons. Salicylate 
of lithium is supposed by some physicians to be of more value than 
the other salts. 

SALOL. 

In appearance, Salol, U. S., is a white crystalline powder, faintly 
aromatic and almost without taste. It is not soluble in water, but is 
in alcohol, and an alcoholic solution forms an imperfect emulsion 
when mixed with water. Salol is also slightly soluble in copaiba, in 
the oils of sandalwood and of turpentine, and in mineral oils. This 
solubility is very useful in prescribing it with these remedies in cer- 
tain diseases of the genito-urinary apparatus (See Gonorrhoea.) 

Salol is a compound of 60 parts of salicylic acid and 40 of car- 
bolic acid, and is decomposed by the pancreatic juice into these two 



318 DRUGS. 

substances. For this reason overdoses will produce symptoms of car- 
bolic-acid poisoning. Thus 20 grains (1.3) taken five times a day 
will cause a man to take 40 grains (2.65) of carbolic acid, which is 
almost a poisonous dose. 

Hesselbach has proved that salol is very apt to affect the kidneys 
unfavorably, and rightly believes it to be contraindicated in all cases 
of renal inflammation of an acute type. 

It is worthy of note that the drug rarely produces untoward 
effects, although at one time a number of observers accused it of 
doing so frequently. 

Salol is used for the same purposes as salicylic acid when the 
stomach is irritated and cannot bear the latter drug, as it is dissolved 
in the small intestine. A dose often used is 10 grains (0.65) an hour, 
but this is too much as a rule, and may produce dangerous symptoms. 
Salol may be given in wafers, capsules, or pills. In pharyngitis 5 
grains (0.3) of salol, given three times daily, is a valuable part of the 
treatment of this affection, and in persons subject to chronic sore 
throat due to the uric-acid diathesis will often produce extraordinary 
results. It is of the greatest value in duodenal catarrh and catarrhal 
jaundice. 

In the treatment of gonorrhoea in all its stages salol may be 
employed by the mouth, as it sterilizes the urine and tends to dis- 
infect or sterilize the urethra at each act of micturition. (See Gon- 
orrhoea.) 

Salol is of very great value in functional disorder of the intestines. 
Indeed, there is no other remedy which can exert the same power for 
good in cases of intestinal indigestion and fermentation. In diarrhoea 
dependent upon such causes salol is one of the best remedies we have, 
since it renders the canal antiseptic, and so removes the cause of the 
disorder, instead of locking the putrid material in the bowel, as does 
opium. In the writer's practice salol has come to be one of the most 
valued drugs in the treatment of the affections just named, and also 
in muscular rheumatism and neuralgia due to exposure In cholera 
morbus the writer's friend, Dr. Fussell of Philadelphia, has found the 
following very useful : 

R.-Salol 3j (4.0). 

Bismuth, subnitrat ^ij (8.0). 

Misturae cretse q. s. ad f^iij (96.0). — M. 

S. — Two teaspoonfuls (8.0) every two hours. 

Wide experience with the drug in the treatment of cholera during 
recent epidemics has proved it to be one of the best remedies we can 
employ in the treatment of this disease. 



SALOPHBN. . 

Salophen has been introduced into medicine as a substitute for 
salol, and is said to possess the advantage of being far less poisonous 
than salol, because in this case the phenol of the salol is replaced 



SANGUINARIA. 319 

by a compound of phenol which is innocuous. Experiments on ani- 
mals seem to indicate that these theoretical advantages are present in 
fact. Like salol, salophen is broken up in the intestine by the juices 
there present, and the result is salicylic acid and acetylparamidophenol. 
Salophen contains about 10 per cent, less salicylic acid than does salol 
(51 per cent.), and appears in the form of thin, white laminae nearly 
insoluble in water. It is tasteless. 

Therapeutics. — For the therapeutics of salophen the reader is 
referred to the article on Salol, as the indications for both drugs are 
identical, save that salophen can probably be used when salol cannot 
be employed. The dose of salophen is from 5 to 20 grains (0.35-1.3) 
three times a day. It can be very effectually combined with phen- 
acetin in the treatment of neuralgia. In subacute rheumatic affec- 
tions it is certainly very useful. 



SANDAL-WOOD OIL. 

Sandal-wood Oil {Oleum Santali, U. S. and B. P.) is derived from 
the wood of Santalum Album, a tree of India, and has a hot, burning 
taste. The odor is very pleasant, and the oil has been used as a per- 
fume. In overdose the oil is capable of producing great irritation of 
the genito-urinary passages. 

Therapeutics. — The oil of sandal-wood is much used by genito- 
urinary surgeons in chronic gonorrhoea and gleet for the purpose of 
stimulating depraved mucous membranes to proper action, and in 
chronic cystitis to act as a tonic to the bladder. 

In the subacute or later stages of bronchitis, when the expectora- 
tion is thick and ropy and the cold is not readily "thrown off," the 
oil of sandal-wood is efficacious. Dr. Daggett strongly recommends 
its use in cases of asthma associated with marked catarrhal symptoms, 
and in the excessive cough following influenza it is of great value. 
In all cases it should be given in capsules in the dose of 5 to 20 drops 
(0.35-1.3), 5 drops (0.35) being generally sufficient, although drug- 
gists generally keep it in 10-minim (0.65) capsules. Oil of sandal- 
wood may irritate the stomach, but it is not so apt to do so as are 



cubebs or copaiba. 



SANGUINARIA. 



Sanguinaria, V. S., or Blood-root, is the rhizome of Sanguinaria 
Canadensis, and has been largely used in medicine, but is a danger- 
ous remedy, possessing more power for harm than good. Its chief 
alkaloid is sanguinarine. 

Poisoning. — Sanguinarine in poisonous dose causes vomiting, purg- 
ing, profuse salivation, and finally tonic convulsions which are spinal 
in origin. Death is due to respiratory failure, but the circulation is 
much decreased in force and frequency. 

Therapeutics. — The employment of sanguinaria in chronic bron- 



320 DRUGS. 

chitis is about the only purpose for which it is now employed to any 
extent. As an emetic in croup it has been largely used, but is too 
irritant and depressant, and ought not to be so employed. According 
to Bartholow, the drug acts as an hepatic stimulant, and is of service 
in g astro-intestinal catarrh with jaundice. 

Administration. — The dose of the fluid extract (Extr actum San- 
guinarice Fluidum, U. S.) is 1 to 5 drops (0.05-0.35) as an expec- 
torant, or 10 to 30 drops (1.0-2.0) as an emetic. If the drug does 
not cause vomiting after an emetic dose, it must not be allowed to 
remain in the stomach. The tincture {Tinctura Sanguinarice, U. S.) 
is the best preparation to use, and may be given in 20- to 30-drop 
doses as an expectorant, and 1 to 3 drachms (4.0-12.0) as an emetic. 
The vinegar (Acetum Sanguinarice) is no longer official, but is given 
in the dose of 10 to 30 drops (0.65-2.0), and as an emetic in the dose 
of 2 to 4 drachms (8.0-16.0). 



SANTONIN. 

Santoninum, U. S. and B. P., is a neutral principle derived from 
Levant Worm-seed or Santonica, which is the unexpanded flower- 
heads of Artemisia pauciflora, a plant of Asia Minor and Turkestan. 
Santonin is soluble in alcohol and chloroform, but less so in water. 
Santoninic acid is formed by warming santonin with alkalies, and 
Hesse has found that santonin is' an anhydride of santoninic acid. 
Santoninic acid is more soluble than santonin. 

Poisoning. — Santonin causes, when taken in overdose, muscular 
tremors, convulsive movements, unconsciousness, and sometimes epi- 
leptiform convulsions. 

One of the most common symptoms of the poisoning is chroma- 
topsia or xanthopsia, during the existence of which all objects look 
yellow. This is due to the staining of the humors of the eye by the 
drug. This may go on to total blindness or pass away in a few days. 
If the color is not yellow, it may be green. The urine is also 
stained — first yellow, then saffron, and finally purple-red, or is 
bloody-looking. This is not due to the presence of blood, but to the 
drug. Poisonous doses of the drug do not cause gastro-enteritis. 

Therapeutics. — Santonin is used for the removal of the round-worm, 
and is very efficacious. It has no influence on the tape-worm. It 
should be given in the manner of all vermifuges (see Worms) — 
namely, at a time when the alimentary canal is empty. Santonin 
is said to have a distinct influence over vision, increasing, in me- 
dicinal amount, its acuity whenever the optic nerve is at fault. In 
urinary incontinence santonin will often produce a cure after all other 
remedies fail. 

Santoninate of sodium (Sodii Santoninas) is a useless, harmful 
preparation, never to be employed except for the benefit of the eye 
when vision fails through disease of the optic nerve. Introduced 
into medicine because of its solubility, it is absorbed into the system, 
which is just what is least desired in an anthelmintic, which should 



SARSAPARILLA. « 321 

seek the worm in the bowel, not by entering the blood. In eye affec- 
tions the dose may be from 2 to 8 grains (0.1-0.6) a day, according 
to the age of the adult. 

Santonin may also be given in the dose of 1 to 2 grains (0.05-0.1) 
to an adult in capsules or wafers. The crystals should be used, not 
the powdered santonin. If the bowels are not opened within ten 
hours after the drug is used, a saline purge should be given, preceded 
preferably by a 2- or 3-grain (0.1-0.15) dose of calomel, taken half 
an hour before, as the flow of bile caused by the mercurial is partic- 
ularly useful in making the worm let go its hold. 

Administration. — Santonin is best given in the form of a troche 
or lozenge (Trochisci Santonini, JJ. S. and B. P.), but it is to be dis- 
tinctly borne in mind, and written on the prescription, that the 
Trochisci Sodii Santoninatis of the JJ. S. P. of 1880 are not to be 
sold to the patient. The troches of santonin itself are now official 
in the JJ. S. P., but if the physician prefers to write for troches, they 
can be made as follows : 

R. — Santonini ....... gr. v (0.3). 

Pulv. sacchari alb ^iij (12.0). 

Pulv. acacia? gr. viij (0.5). 

Misce bene, et adde 

Acacia? mucilag gtt. xvj (1.0). 

Aquae q. s. 

Ft. in troches No. x. 
S. — One or two lozenges, as directed. 



SARSAPARILLA. 

Sarsaparilla, U.S., is the root of Smilax Officinalis, Smilax Medica r 
and other species of Smilax, growing chiefly in Central America. It 
is known in the B. P. as Sarsce Radix. The drug is devoid of any 
physiological action, yet seems to possess some power over the general 
condition of the system. Thus while sarsaparilla seems utterly with- 
out effect in the hands of most physicians when given alone, it often 
seems to do good and to increase the effects of other drugs when com- 
bined with them, so that some cases of syphilis which are of an obsti- 
nate character will yield to iodide of potassium and sarsaparilla when 
the iodide alone fails. Sarsaparilla is largely used in domestic med- 
icine as a "blood-purifier," and is a prominent constituent of many 
patent medicines. 

Administration. — Sarsaparilla is most commonly given in the form 
of the compound syrup {Syrupus Sarsaparilla Compositwn, JJ. S.), 
composed of sarsaparilla, sassafras, guaiacum-wood, liquorice, pale 
rose, gaultheria, anise, and senna, dose 1 to 4 fluidrachms (4.0-16.0). 
(See Iodide of Potassium.) The other official preparations of the 
JJ. S. P. are the compound decoction (Decoctum Sarsaparilla^ Com- 
position), composed of the same principal ingredients as the compound 
syrup, except that anise, senna, pale rose, and mezereum are omitted, 
dose 4 to 6 fluidrachms (16.0-24.0); the compound fluid extract 
(Extractum Sarsaparilla? Fluidum Compositum), similar to the syrup 

21 



322 DRUGS. 

in composition, dose ^ to 1 fluidrachm (2.0-4.0) ; and the fluid extract 
{Extr actum Sarsaparilloe Fluidum), dose J to 1 fluidrachm (2.0-4.0). 
The B. P. preparations are — a decoction (Decoctum Sarsos), dose 2 to 
10 fluidounces (64.0-320.0); a compound decoction (Decoctum Sarsce 
Compositum), which is identical with the decoction of the U. S. P. ; 
and a liquid extract {Extr actum Sarsai Liquidum), dose \ to 4 fluid- 
drachms (2.0-16.0). 

SAVINB. 

Sabina, U. S. {Savince Cacumina, B. P.) is the tops of the Juniperus 
Sabina, an evergreen shrub of Northern Europe, Asia, and America. 
It contains an official volatile oil {Oleum Sabince, U. S. and B. P.). 
Locally applied, it is more of a counter-irritant than is turpentine, and 
if swallowed in poisonous amount causes nausea, vomiting, gastro- 
enteritis, unconsciousness, suppression of urine, and death. If the 
individual be a pregnant female, abortion takes place as death 
approaches, but very rarely before this time. Profuse flooding 
nearly always accompanies the act. 

Therapeutics. — The oil, taken in the dose of 5 to 10 drops (0.35- 
0.65), repeated every three or four hours, acts as a powerful stimulant 
to the uterus and ovaries, causing hyperemia and aiding in the pro- 
duction of menstruation in cases of amenorrhoea. It may also be 
employed to give tone to the uterus in monorrhagia. The drug is 
best given in emulsion or capsule. The fluid extract {Extr actum 
jSabincc Fluidum, U. S.) is given in the dose of 5 to 15 minims (0.35- 
1.0) ; the tincture {Tinctura Sabince, B. P.) in the dose of 20 minims 
to 1 drachm (1.3-4.0). The ointment {Unguentum Sabince, B. P.) 
is used as an external application to irritate the skin. 



SCAMMONY. 

Scammonium, U. S. and B. P., is a resinous exudate from the root 
of Convolvulus Scammonia, growing in Asia Minor and Syria. Its 
active principle is sometimes called jalapin. 

Therapeutics. — Scammony is an irritant, drastic, hydragogue purge, 
which causes a good deal of griping and exerts a cholagogue effect. 
If any inflammatory action of the bowels is present its use is contra- 
indicated. 

The ingestion of poisonous doses is to be followed by treatment 
suitable to gastro-enteritis. Scammony is given in the dose of 2 to 5 
grains (0.1-0.35), always in combination with some other similar 
drug — as, for example, colocynth. Scammony forms part of the com- 
pound extract of colocynth (Extractum Oolocynthidis Compositum, 
U. S.), the dose of which is 1 to 3 grains (0.05-0.15) as a lax- 
ative or 5 to 20 grains (0.35-1.3) as a purge. The resin (Besina 
Scammonii, U. S. and B. P.) is given in the dose of 3 to 8 grains 
(0.15-0.6). The B. P. preparations of scammony are Mistura Scam- 
monii, dose \ to 2 ounces (16.0-64.0) ; Confectio Scammonii, dose 10 to 



SCO PARI US AND SPARTEINE. 323 

30 grains (0.65-2.0); Pilula Scammonii Compo sit a, dose 5 grains 
(0.35); and Pidvis Scammonii Compositus, dose 10 to 20 grains 
(0.65-1.3). The last two preparations are composed of scaniruony, 
ginger, and jalap. 



SCOPARIUS AND SPARTEINE. 

Scoparius, U. S. (Scopari Oacumina, B. P.), or Broom, is the tops 
of the Sarothamnus Scoparius. It contains scoparin and sparteine, 
the first being a crystalline principle and the second a liquid alkaloid. 
The second (sparteine) is the alkaloid used in medicine in the form of 
a sulphate (Sparteines Sulphas, U. S.), which is a crystalline salt readily 
soluble in water. 

Physiological Action. — As scoparius depends for its medicinal value 
almost entirely upon sparteine, what is here said applies to both the 
crude drug and the alkaloid. 

Nervous System. — Sparteine acts on the nervous system very 
decidedly if given in large dose, depressing the brain and spinal cord, 
chiefly in its motor tracts, thereby causing a decrease of reflex action 
and motor power, ending in complete paralysis. These changes occur 
both in man and in the lower animals. The heart is said to be stopped 
in systole. 

Circulation. — Upon the circulation sparteine acts as a stimulant. 
It quickens the pulse-rate in moderate doses, and also raises arterial 
pressure. The force of the contraction of the ventricles is also increased. 
In very large poisonous doses the drug acts as a circulatory depressant. 

Respiration. — Upon this function in small amounts sparteine 
has no effect, but poisonous doses kill by paralysis of the respiratory 
centre. 

Poisoning. — The symptoms of poisoning consist in trembling and 
inco-ordination of movement, and clonic and tonic convulsions, fol- 
lowed by a second stage of depression of the nervous system and 
general enfeeblement. 

Therapeutics. — Sparteine has been recommended in all states of 
the heart in which digitalis is of service, and it is sometimes useful 
in those fairly frequent cases where digitalis fails. In cardiac arhyih- 
mia or palpitation it is thought to be of great service by those who 
have used it most. Clark found it of value in Graves s disease and 
in nearly every circulatory abnormality, but in the judgment of the 
author of this book sparteine is not a very useful drug — one only to 
be turned to as a last resource after more generally known remedies 
fail; or, in other words, it is not a remedy to be used as a "stand- 
by" in the manner in which digitalis is employed. 

While some clinicians have found sparteine of value, many of them 
have not. In the few cases in which it has been used by the writer 
it entirely failed to be of service, perhaps because the cases were so 
desperate that all the other remedies had failed. The dose is as vari- 
able as its action. Some state it to be -^ of a grain (0.003), while 
still others recommend 2 to 4 grains (0.1-0.2). A small dose should 



324 DRUGS. 

be used at first, and rapidly increased until some effects ensue. To 
get the best effects it should be given every two hours in the dose of 
i of a grain. The drug should be given in watery solution. 

Potts claims to have found sparteine of value in tremor, as in 
paralysis agitans, in the dose of \ to J grain (0.015-0.025) three 
times a day. 

Scoparius itself is used in decoction, made b} T adding J an ounce 
(16.0) of the broom-tops to a pint (f litre) of water, and boiling them 
down to a J pint (250 cc). Of this, an ounce should be taken every 
three hours. This decoction is one of the most efficient diuretics in 
cardiac dropsy. An official fluid extract (Extr actum Scoparii Fluidum, 
77. S.) is given in the dose of 30 drops (2.0). The official preparations 
of thei?. P. are — a decoction (Decoctum Scoparii), dose 1 to 3 ounces- 
(32.0-96.0), and the juice (Succus Scoparii), dose 1 to 2 drachms 
(4.0-8.0). 

SBIDLITZ POWDER. 

Under the official name of Pulvis Effervescens Compositus the 
U. S. P. recognizes a purgative powder (Seidlitz Powder, B. jP.) 
made by taking the bitartrate of sodium and potassium, or Rochelle 
salt, 120 grains, and bicarbonate of sodium 40 grains, which are 
wrapped in blue paper, and 35 grains of tartaric acid placed in a 
white paper. The contents of each paper are dissolved in a little 
water — half a tumblerful — and the two solutions added to one another 
and swallowed during effervescence. As much as two powders may 
be used, but this is generally too large an amount unless full purgation 
is needed. In sick stomach associated with constipation, when a whole 
powder cannot be retained, the two powders should be divided into 
fourths, and a fourth added to a fourth dissolved in a half-wineglass- 
ful of water and taken every fifteen minutes until the entire powder 
is ingested. This will often settle the stomach and produce purgation. 



SENEGA. 

Senega, U. S. (Senegas Radix, B. P.), is the root of Poly gala 
Senega, a small plant of the United States, containing a principle 
known as polygalic acid and senegin. 

Therapeutics. — Senega is used in medicine as a stimulating expec- 
torant in the subacute and chronic forms of bronchitis. It has also 
been employed as a diuretic in cardiac dropsy or that due to renal 
disease. In cardiac disease it should not be used, and indeed it is 
rarely employed at present except in combination with other drugs 
in expectorant mixtures. 

Administration. — Senega is used in the form of the fluid extract 
{Extr actum Senegas Fluidum, U. S.), dose 10 to 20 drops (0.65-1.3), 
and the syrup (Syrupus Senegas, U. S.), dose 1 to 2 drachms (4.0- 
8.0). It is also used in Coxe'sHive Syrup. The official preparations- 
of the B. P. are — a tincture (Tinctura Senegas), dose 1 to 2 drachms 



SENNA. 325 

{4.0-8.0), and an infusion (Infusum Senegce), dose 1 to 2 ounces 
(32.0-64.0). 

SENNA. 

Senna, U. S., is the most drastic of the laxative purges used for 
the relief of constipation. It is the leaflets of Cassia Acutifolia and 
Cassia Elongata, and contains a very acrid irritant purgative princi- 
ple known as cathartic acid. Senna is official in the B. P. as Senna 
Indica and Alexandrina. 

Physiological Action. — Senna acts as a purge, producing copious 
stools, often with a great deal of griping if it is used alone. Accord- 
ing to Rutherford and Vignal, it acts very materially in increasing 
the flow of bile, but it is seldom, if ever, used in medicine as a chola- 
gogue, although, according to Prevost and Binet, cathartic acid has 
^in influence over biliary secretion. Hess has found that the drug 
acts directly as a stimulant upon the mucous membranes, and so pro- 
duces a local peristalsis as it is moved along. It is also known that 
the drug is eliminated in the milk, and for this reason care should 
be taken in giving the drug to nursing mothers, as it will purge the 
nursling. 

Administration. — Senna is generally combined with other drugs 
for the relief of constipation, but may be used alone. If this is 
•done, the fluid extract (Extractum Sennas Fluidum, U. S.) may be 
employed in the dose of 1 to 2 drachms (4.0-8.0) to a child or 4 
drachms (16.0) to an adult. It is, however, ahvays better to give 
children the more agreeable confection (Confectio Sennce, U. S. and 
B. P.) in the dose of J drachm (2.0) to a child or 1 to 2 drachms 
(4.0-8.0) to an .adult. As the confection is apt to cause gastric dis- 
order if used continuously because of the sugar contained in it, its 
use is limited to a certain class of cases. 

In the treatment of the constipation of pregnancy senna is thought 
to be very useful. Under the name of Black Draught a mixture of 
senna, manna, and sulphate of magnesium has been largely used 
{Infusum Sennce Composition, U. S.) in the dose of 4 ounces (128.0). 
It is an active hydragogue purge. The syrup (Syrupus Sennce, U. S. 
-and B. P.) is given in the dose of 1 to 4 drachms (4.0-16.0). 

One of the best ways to use senna is in the compound liquorice 
powder (Pulvis Grlycyrrhizce Compositus, TJ. S. and B. P.), which is 
a good laxative in the dose of 20 to 30 grains (1.3-2.0), Compound 
liquorice powder is composed of senna, liquorice, fennel, washed 
sulphur, and sugar. 

Infusum Senna?, B. P., is given in the dose of 1 to 2 ounces 
(32.0-64.0); Mistura Sennce Composita, B. P., in the dose of 1 to 2 
ounces (32.0-64.0), and Tinctnra Senna?, B. P, in the dose of 1 to 4 
drachms (4.0-16.0). 

Senna, because of its chrysophan, may stain the urine carmine if 
that fluid is alkaline, or yellow if it is acid. No alarm should be felt 
if the color appears in this secretion. Often it is necessary to warn 
the parents of a child of the possibility of such an occurrence, in 



326 DRUGS. 

order to prevent any fright on the part of the mother, who otherwise 
might think that hematuria was present. 



SERPENTARIA. 

Serpentaria, XT. S. (Serpentaria Rhizoma, B. P.), or Virginia 
Snakeroot, is the rhizome and rootlets of Aristolochia Serpentaria 
and Aristolochia Reticulata, plants of the Southern United States. 
It contains an active principle, aristolochin, which is never used in 
medicine. 

Therapeutics. — Owing to the rather pleasant, warm taste of ser- 
pentaria, and the fact that it stimulates secretion, it is used largely as 
a vehicle for other more potent remedies. It has tonic properties, 
and in consequence has been largely used in the treatment of atonic 
dyspepsia and indigestion. It is even said to be a sexual stimulant, 
but this is doubtful, to say the least. In overdose it is an irritant, 
and will cause vomiting and purging if large amounts are taken. 

Administration. — Serpentaria is given in the form of the fluid 
extract (Extr actum Serpentaria Fluidum, U. S.) in the dose of 10 
to 40 drops (0.65-1.3), and the tincture (Tinctura Serpentaria, U. S. 
and B. P.) in the dose of J to 2 drachms (2.0-8.0). It also enters 
into Huxham's Tincture of Cinchona [Tinctura Cinchona* Composita, 
U. S. and B. P.). Infusum Serpentaria?, B. P., is given in the dose 
of 1 to 2 ounces (32.0-64.0). 



SILICATE OP POTASSIUM OR SODIUM. 

Soluble Glass, or Silicate of Potassium or Sodium, occurs as a 
clear syrupy fluid, and is not official. It is used as a splint in the 
dressing of fractures and sprains, as it rapidly becomes hard and 
immovable when painted over the bandages. Silicate of potassium 
or sodium may be universally substituted for plaster of Paris. The 
silicate of sodium is official as Liquor Sodii Silicatis, U. S. P. 



SOAP. 

Sapo, TJ. S. (Sapo Buris, B. P.), is prepared from any alkali and 
fixed oil, although soda and olive oil are most frequently employed 
in the manufacture of the soaps which are used medicinally. Castile 
soap, if good, is the best representative of a pure soap that we have. 

Soap may be cut into the form of a suppository and used to pro- 
voke movements of the bowel in young children who are suffering 
from constipation by placing it just inside the anus, having previously 
dipped it into water one instant to make it slippery. It may also be 
used as an enema, dissolved in warm water, or a mixture known in 
Philadelphia as the "House Mixture" may be employed in the case 
of an adult. This consists of a mixture of water, soft-soap, and 



SODIO-SALICYLATE OF THEOBROMINE. 327 

molasses in varying proportions, and if flatulence is present turpentine 
and olive oil are added to it. The preparation is as efficient as it is 
cheap and dirty. Soap is also used as an antidote to many poisons 
and as an aid to emetics. 

Green Soap (Sap>o Mollis, U. S. and B. P.) is not generally green, 
but brown. It is a soft soap made by the use of potash and olive oil, 
and is largely used by dermatologists in the treatment of eczema and 
similar skin diseases where a detergent, stimulating application is 
needed. It is sometimes called " German soft soap," to separate it 
from the ordinary soft soap, or the common sapo mollis, of this coun- 
try, which is an impure substance often made of rancid fats, contain- 
ing a large excess of alkali and never used except for scouring pur- 
poses. Green soap is not commonly employed as green soap, but in 
the liniment (Linimentum Saponis Mollis, U. $.), which is to be 
thoroughly rubbed into the part when used medicinally, well washed 
off, and afterward simple cerate or some other soothing salve applied. 

Soap Liniment [Linimentum Saponis, U. S. and B. P.), or Opo- 
deldoc, as it is called in domestic medicine, is largely used for rubbing 
stiff muscles and sprains. It is generally employed to carry more 
active external remedies, such as opium or aconite. 

R. — Tinct. aconiti ] 

Tinct. belladonna? > aa fgij (8.0). 

Tinct. opii J 

Liniment, saponis q. s. ad fljvj (192.0). — M. 

Soap Plaster (Emplastrum Saponis, U. S.) is used as a thick, 
heavy protective in bed-sores or where bed-sores are feared. It is 
also used as a support about sprained joints. 



SODIO-SALICYLATE OP THEOBROMINE. 

This compound, known as diuretin (or sodio-theobromine-salicy- 
late), derives its name from the extraordinary power which it is said to 
possess of producing a great increase in the urinary flow from the 
kidneys. This power depends entirely upon the theobromine, which 
is a crystallizable, bitter, and Volatile alkaloid, closely allied to caf- 
feine and xanthine, and derived from the seeds of Theobroma Cacao, or 
the source of ordinary chocolate. Owing to the insolubility of theo- 
bromine, it has been found necessary to combine it with sodium salicy- 
late, as under these conditions it is readily absorbed. 

The diuretic properties of this alkaloid were first discovered during 
a series of experiments made by Schroder in Strasburg in 1889, who 
found that the diuresis produced in man and the lower animals was 
very marked. A large number of clinical trials in Europe and 
America have confirmed his observations, but there are a number of 
cases in which it signally fails, particularly in chronic Bright's disease. 

Theobromine does not have so stimulating an effect on the heart as 
does its relative caffeine, so that the circulatory effect, while showing 
a stimulant rather than a depressing tendency, is very slight. It 



328 DRUGS. 

slightly increases muscular power, but its peculiar affinity for the 
renal structures surpasses all its other activities. 

As the action of the drug depends upon its ability to stimulate the 
.secreting epithelium of the kidney, the physician should remember 
that in cases of advanced renal disease, where the secreting structures 
a;e almost entirely destroyed, no result can be expected from its 
administration ; but it is probable that the drug is useful in almost 
all conditions of dropsy, whether due to renal inactivity or cardiac 
disease, and is harmless to the patient even if the diuretic effect does 
not ensue. The only contraindication to the use of theobromine or 
diuretin is the presence of acute nephritis, when, of course, sedatives 
rather than stimulants are needed. So far as the writer is aware, no 
study as to the proportion of solids and liquids in the urine under the 
influence of this drug have been made, but the fact that it stimulates 
the epithelium or secreting structures of the kidney would indicate 
that the solids are increased. 

As diuretin only contains from 30 to 50 per cent, of theobromine, 
it has to be given in very large amounts, as much as 1 to 2 drachms 
(4.0-8.0) in twenty-four hours, preferably in divided doses of from 
10 to 20 grains (0.65-1.3) in capsule or in warm water. The former 
method is the better, as the taste of the drug is disagreeable and 
soapy. 

It must not be exposed to the air, as it undergoes decomposition. 

In all the cases in which the writer has tried sodio-salicylate of 
theobromine he has failed to see any effect produced, and, while he 
has no confidence in the drug, he mentions it because others claim 
to have obtained good results from its use. 



SODIUM. 

Sodium is a metallic element, the salts of which are usually white 
and colorless. It is not used in medicine, but many of its salts are 
employed. Unlike the potassium salts, the salts of sodium seem to 
exert comparatively little effect upon the animal economy. The salts 
vary in their power with the acid forming them. 

Acetate of Sodium (Sodii Acetas, U. S. and B. P.) is rarely if ever 
used in medicine as a substitute for acetate of potassium. The dose is 
20 to 40 grains (1.3-2.65) three times a day. 



SODIUM BTHYLATE. 

Sodium Ethylate is a whitish powder, decomposed in the presence 
of water into alcohol and caustic soda, but soluble in absolute alcohol 
without decomposition. 

Sodium ethylate is employed in medicine as a depilatory — that is, 
for the purpose of removing hairy growths. To accomplish this pur- 
pose it is necessary that the growth be clipped close to the skin, and 
that the drug be dissolved in absolute alcohol and applied over the 
roots of the hair with a glass rod. 



SOLANUM CABOLINENSE. 329 

Soon after this application a crust forms, which should not be 
detached for two or three weeks, but which, on its removal at the 
end of this time, generally shows that all the roots of the hair have 
been destroyed. If not, the operation may be repeated as soon as 
the skin is in a condition to bear it. To prevent pain, a 5 per cent, 
solution of cocaine may be used hypodermically at the spot to be 
cauterized. It is worthy of remembrance that moles and small birth- 
marks, or naevi, may be relieved by a similar application. 



SODIUM HYPOSULPHITE. 

Hyposulphite of Sodium, or Thiosulphite of Sodium, occurs in 
large, transparent, colorless plates which effloresce when exposed to 
the air. It has slight alkaline reaction, is soluble in about equal parts 
of water, but insoluble in alcohol. 

Therapeutics. — Hyposulphite of sodium is used in the proportion 
of 1 drachm (4.0) to the ounce (32.0) of water or lard in the treat- 
ment of parasitic skin diseases, particularly those due to the tri- 
cophyton fungus, such as pityriasis versicolor. It is also very useful, 
locally applied, in poisoning from poison ivy, and in cases of pruritus 
•due to other causes, in the strength of J a drachm (2.0) to the ounce 
(32.0) of water. In malarial hematuria hyposulphite of sodium is 
often given with advantage in the dose of from 10 to 30 grains (0.65- 
2.0) every four hours. How it acts in this condition we do not know. 



SODIUM SULPHATE. 

Sodii Sulphas, U. S. and B. P., or Glauber's salt, is one of the most 
irritant of the saline purges, rarely used in medicine for human beings, 
but largely employed by veterinarians. The purgative dose for man 
is half an ounce to an ounce (16.0-32.0). If any intestinal inflam- 
mation is present, it is contraindicated. It produces large watery 
stools, with a good deal of griping. Sulphate of sodium is a promi- 
nent constituent of Carlsbad water, Hunyadi Janos, Hunyadi Arpad, 
and similar waters. 



SOLANUM CAROLINENSE. 

Solanum Carolinense, or Horse Nettle, is a low perennial plant of 
the natural order Solanacece, a native of the South-eastern United 
States. 

The drug has been introduced into medicine for the purpose of 
relieving epilepsy, particularly when the disease occurs in childhood. 
In a very limited employment of the drug the writer has found it 
very serviceable in diminishing the frequency and severity of the 
-attacks. The dose of the fluid extract is 2 to 15 minims (0.1-1.0) 
three times a day. 



330 DRUGS. 



SOMNAL. 



Somnal is stated to be ethylated chloral-urethan, and seems to 
possess marked hypnotic power. It is a clear, colorless liquid of a 
hot, burning taste, resembling sweet spirit of nitre. The dose is 20 
to 40 drops (1.3-2.6) in liquorice-water or syrup of raspberry, and 
the sleep produced by it is said to last seven to eight hours. No 
very definite reports have yet been made concerning it, but in a 
number of cases in which the writer has used it it has acted veiy 
well, although drowsiness is usually present on the next day. 



SOYA BEANS. 

Soya Beans are derived from Glycine hispida, a plant of Japan 
and China. These beans are ground up into a flour, and from this 
is made a bread which has proved itself very useful in diabetes mel- 
litus. It is supposed to contain less than 3 per cent, of starch or 
sugar, and by many authorities is regarded as superior to the best 
gluten bread. The cost is practically the same as that of good gluten 
bread, and the taste affords a pleasant change for the patient. If 
crackers are made of the soya-bean flour, they will remain good 
indefinitely, but in warm w^eather the bread must be freshly made 
every two or three days. The beans themselves contain a purga- 
tive oil, and this must be removed from the flour before it is used. 
Unless almond bread is unusually well made, soya bread is far prefer- 
able in every way. 

SOZOIODOL. 

Sozoiodol is an antiseptic preparation first made and employed by 
one of our own countrymen in San Francisco, but at that time the 
preparation of it was so imperfectly carried out that foreign matters 
made it too irritating for general use, and it was discarded, only to 
be better prepared and more widely used in Germany some years 
later. 

Therapeutics. — Sozoiodol has been found of value as an antiseptic 
and disinfectant in the treatment of wounds which are in an unhealthy 
state, and for acute stomatitis and 'pharyngeal catarrh it may be 
employed locally in the form of a 5 per cent, watery solution. It 
has also been found useful in acute purulent conjunctivitis and in oph- 
thalmia neonatorum, in the proportion of 2 parts of sozoiodol to 30' 
parts of water. In urethritis of a specific type we may employ the 
preparation known as zinc-sozoiodol in a 2 per cent, solution with 
advantage, and this compound is also of value in mild and malignant 
vaginitis if preceded by pyroligneous acetic. acid or nitrate of silver^ 
applied by means of a speculum. 

In the treatment of gynaecological cases, particularly in catarrh of 
the cervix uteri, Nitschman uses sozoiodol in the form of a powder 
applied by means of a tampon with good results, and it would seem 



SPIGELIA. 331 

to be worthy of trial in many other states of the mucous membranes 
than those just named. 



SPIGELIA. 

Spigelia, U. S., Pinkroot, is the root and rhizome of Spigelia 
Marilandiea, or Carolina Pink, a plant of the Southern United 
States. 

Poisoning. — Almost immediately after the ingestion of a poisonous 
dose of spigelia the animal has short and quick expiratory move- 
ments, amounting almost to a cough. 1 Soon after the pupils become 
widely dilated, the eyeball is turned inward, and at the same time 
the orbit becomes very fixed in this position, so that the eye cannot 
follow any object, such as a pencil, when it is moved from side to 
side. Constant retching, with no result, now comes on, the animal 
standing and apparently suffering from no sensory or motor palsy. 
There is no change in gait. Soon after this marked exophthalmia is 
developed. The retching, having lasted about five minutes., now 
passes off, and at this time signs of muscular weakness and lack of 
co-ordination appear, the walk becoming staggering both in the fore 
and hind legs. The respirations now become very rapid, resembling 
those of a dog after a long run on a hot day. The tongue hangs 
from the mouth and is dry and red, and the nose is hot and no longer 
moist. Muscular power is progressively lost, so that the dog fre- 
quently falls when endeavoring to walk, but sensation does not seem 
to be affected. About this period the animal lies down and passes 
into a deep sleep, which, in turn, soon changes into coma, and death 
follows without any movement being made, evidently from a general 
failure of vital force. The respirations, as death approaches, become 
slow, and are finally extinguished simultaneously with cardiac arrest. 
The palsy is spinal in origin, the motor and sensory nerve-trunks and 
the muscles escaping the paralysis. 

Therapeutics. — Spigelia is one of the most efficient remedies in the 
treatment of round-worms, and is not dangerous when given with 
care. When employed for the removal of worms the usual precaution 
should be taken in regard to the ingestion of food (see article on 
Worms), and the drug should be followed by a purge to sweep out 
the worm while it is narcotized. The purge should be one which is 
rapid in its action, such as the sulphate of magnesium. 

Administration. — The dose of spigelia in the form of the fluid 
extract {Extr actum Spigelian Fluidum, U. S.) is 2 drachms (8.0); 
that of the unofficial fluid extract of spigelia and senna (Extr actum 
Spigelian et Senna? Fluidum) is \ to 1 drachm (2.0-4.0) for a child 
of two years of age ; \ an ounce (16.0) is the dose for an adult. The 
addition of fluid extract of senna makes the drug more efficient, and 
the mixture is generally not disliked by children. It is to be remem- 
bered that this latter mixture is no longer official. 

1 See investigation by author in The Medical News, March 12, 1887. 



332 DRUGS. 



SQUILL. 



Scilla, IT. S. and B. P., is the sliced bulb of Urginea Maritima, 
a plant of the countries bordering on the Mediterranean. It con- 
tains scillin, scillipikrin, and scillitoxin, all of which possess poison- 
ous properties and none of which are used in medicine alone, except 
by a few persons. 

Poisoning. — In poisonous doses squill produces vomiting, purging, 
dulness, stupor, intermittent palsy, convulsions, and death in ten to 
twenty hours. These symptoms are preceded by a great fall in tem- 
perature. The urine is suppressed or bloody and acute nephritis is 
produced. Gastro-enteritis may be marked. 

Therapeutics. — Squill is largely used as a stimulant or irritant 
diuretic, not to affect the renal epithelium directly and promote secre- 
tion, but rather to tone up and excite to normal effort a kidney 
depressed by disease, as in very chronic Bright 's disease or renal con- 
gestion from cardiac trouble. In cardiac dropsy, combined with digi- 
talis, squill is a standard and much-used remedy, and is undoubtedly 
of value in aiding in the absorption of effusions in the pericardium, 
pleura, and abdomen. Squill is usually given in dropsy, in pill form, 
as follows : 

R .— Pulv. scillse gr. x (0.65). 

Pulv. digital, fol . . gj (1.3).— M. 

Ft. in pil. No. x. 
S. — One t. d. after meals. 

The employment of squill in bronchitis, although largely resorted 
to, is not a very good practice, since its irritant action on the kidneys 
and stomach may cause trouble. The period for its administration is 
in the beginning of the second stage, when secretion is scanty or so 
excessive as to need proper stimulation of the mucous membranes to 
bring on a healthy action. Sometimes Coxe's Hive Syrup is used, 
either as an emetic in drachm doses every ten minutes until it acts, 
or as an expectorant in the dose of 30 drops to 1 drachm (2.0-4.0) for 
an adult. As it contains antimony, it should be given with care. 

Administration. — The fluid extract (Extractum Scillce Fluidum, 
U. S.) is given in the dose of 1 to 5 drops (0.05-0.3); the tincture 
(Tincturm Scilla?, U. S. and B. P.) in the dose of 5 to 30 drops 
(0.3-2.0); the vinegar of squill (Acetum Scilla?, U. S. and B. P.) in 
the dose of 10 drops to J drachm (0.65-2.0). The compound syrup 
{Syrupus Scillce Compositus, U. #.), or Coxe's Hive Syrup, is com- 
posed of squill, tartrate of antimony and potassium, precipitated 
phosphate of calcium, alcohol, sugar, and water, and is given in the 
dose of 20 drops to 1 drachm (1.3-4.0). 

The following prescription will be found useful in bronchitis in its 
subacute stages in a child of one to five years : 

R.— Vini ipecac fgj (4.0). 

Tincturse scillse f gij (8.0). 

Syr. tolutan f 3v (20.0). 

Aquse fgj (32.0).— M. 

S. — Teaspoonful (4.0) every three or four hours. 



STILLINGIA. 333 

The plain syrup (Syrupus Scilloe, U. S. and B. P.) is given in the 
dose of J to 1 drachm (2.0-4.0), the honey (Oxymel Scilloe, B. P.) 
in the dose of J to 1 drachm (2.0-4.0), and the compound pill (Pilulce 
Scillce Composita, B. P.) in the dose of 5 to 10 grains (0.3-0.65). 



STARCH. 

Amylum, U. S. and B. P., is wheat starch, but good corn starch 
is usually employed by many persons. In very fine powder starch is 
used as a dusting powder in intertrigo or chafing. Its more import- 
ant uses are, however, its employment in the form of starch-water for 
carrying drugs into the rectum, and in the form of a poultice for cases 
of skin disease where it is desired to remove crusts. 

Starch-water is made by boiling starch in the proportion of 2 table- 
spoonfuls to 1 pint of water, which is then boiled to paste and diluted 
by the addition of warm water to the consistency of syrup. Starch- 
water is not only useful as a vehicle for drugs given by the rectum, 
but as a sedative injection in proctitis and rectal irritation. 

The starch poultice is made by boiling the starch to a pasty con- 
sistence or adding enough boiling water to a paste made by rubbing 
cold water and starch together to produce a gelatinous mass. 30 
grains (2.0) of boric acid to the ounce (32.0) render it antiseptic. 



STILLINGIA. 

Stillingia, TJ. #., Queen's Root, is the root of Stillingia Sylvatica, 
a plant of the United States, the active principle of which is stil- 
lingin. 

Physiological Action. — There can be no doubt that this drug acts 
in two ways : first, by its immediate effects on the system, and second, 
by its more slowly-shown alterative influences. In overdose it causes 
bilious purging, increased heart-action, and active secretion from the 
bronchial mucous membrane. 

Therapeutics. — Stillingia is highly recommended in habitual con- 
stipation, as it increases intestinal secretion, and it is even said to act 
as a specific in hemorrhoids dependent largely for their existence upon 
hepatic engorgement and intestinal atony. 

Bartholow recommends the following prescription under these cir- 
cumstances : 

R.— Extract, stillingia? fluid f^v (20.0). 

Tincturae belladonnas ~\ 

Tincturae nucis vomicae [• . . . . aa f ^j (4.0). — M. 
Tincturae physostigmatis J 
S. — 20 drops (1.3) in water t. d. before meals. 

Tincture of aloes may also be added to this prescription if consti- 
pation is present. In syphilis of an obstinate and rapid type stillingia 
should be used as an aid to other drugs, 

In pasty -looking, white, " putty-faced " children, who are aneemic 



334 DRUGS. 

or strumous, and who never have any appetite, or are subject to mid- 
dle-ear trouble and general debility, stillingia is of value. It should 
be used, under these circumstances, for some time. 

The only official preparation is the fluid extract {Extractum 
Stillingice Fluidum, tl. S.), which should always be made of the 
fresh root, the dose of which is 10 to 60 drops (0.65-4.0). 



STRAMONIUM. 

Jamestown Weed, or Datura Stramonium, is official in the form 
of the leaves {Stramonii Folia, U. S.) and the seeds (Stramonii Semen, 
U. S. and B. P.). It contains an alkaloid known as daturine, which 
is physiologically identical with atropine. 

Physiological Action. — (See Belladonna.) 

Therapeutics. — The uses of stramonium are identical with those of 
belladonna. 

Administration. — The extract (Extractum Stramonii Seminis, 
U. S. and B. P.) is used in the dose of J to J grain (0.01-0.03), 
the fluid extract (Extractum Stramonii Seminis Fluidum, U. S.) in 
the dose of 1 to 5 drops (0.05-0.35), and the tincture (Tinctura 
Stram.onii, U. S. and B. P.) in the dose of 5 to 30 drops (0.3-2.0). 
It should be remembered that this tincture is nearly twice as strong 
as the tincture prepared according to the U. S. P. of 1880. The 
ointment ( Unguentum Stramonii, U. S.) is used for the same purposes 
as is belladonna ointment. The dose of daturine is Y20- to -^ of a 



;rain (0.0005-0.0008). 



STRONTIUM. 



This substance has lately been introduced into medicine in the 
form of the bromide (Strontii Bromidum, U. S.), lactate (Strontii 
Lactas, XI. $.), iodide [Strontii Iodidum, U. S.) and phosphate, 
largely through the studies of Laborde, See, Paul, and others. The 
bromide of strontium is used for precisely the same effects as are the 
other bromides, but it is claimed that, as the strontium has a distinct 
nutritive influence over the system, the well-known disadvantages of 
the potassium salt are avoided. The dose of bromide of strontium 
is from 30 to 60 grains (2.0-4.0). In addition to the ordinary effect 
of bromides, See found the bromide of strontium to be very useful in 
overcoming attacks of gastric indigestion associated with pain in the 
stomach and hyperacidity ; and the author has confirmed this state- 
ment. The lactate of strontium seems to be indicated chiefly in 
cases of albuminuria due to renal atony. It does not increase urinary 
flow, and is contraindicated in the presence of the uraemia and high 
fever of acute parenchymatous nephritis. . In chronic parenchyma- 
tous nephritis, such as is due to rheumatism or gout, it is of value. 
Unfortunately, as soon as the lactate of strontium is withdrawn the 
albuminuria is apt to recur if the disease is not entirely cured. The 
dose of the lactate of strontium is 60 to 100 grains (4.0-7.0) a day. 



SUGAR. 335 

Fortunately, strontium possesses no toxic power whatever, and 
overdoses are not followed by any bad consequences. If the stron- 
tium is contaminated by barium, serious effects are produced. The 
writer has often been much disappointed in the use of the lactate of 
strontium in albuminuria, but others of wide experience seem to 
regard it as very constant in producing good results. 



STROPHANTHUS. 

Strophanthus, U. S. and B. P., is an African plant (/Strophanthus 
hispidus), from the seed of which the natives make kombe arrow- 
poison. There are many varieties of Strophanthus. The active 
principle is strophanthin, from which is derived strophanthidin. It 
has been claimed that strophanthus contains a local anaesthetic prin- 
ciple, but Dr. de Schweinitz and the author found it to be possessed 
of this power only in dogs and not in man. 

Therapeutics. — Strophanthus may be used in all forms of cardiac 
disease to supplant digitalis, but it is not its equal. 

From the cases of cardiac disease seen frequently by the writer he 
has reached the conclusion that digitalis gives relief to patients under 
the age of twelve years in a much smaller proportion of cases than it 
does in adults, and that, though the stomach is no more frequently 
disordered, increased dyspnoea, nervous irritability, and cyanosis often 
follow its use. On the other hand, strophanthus generally gives good 
results in this class of cases. 

As every one knows, there are a certain number of cases where 
digitalis seems to do harm in adults, the explanation being that under 
such circumstances the ventricle is so overstimulated that the auricle 
cannot empty itself thoroughly, and becomes congested in consequence. 
Strophanthus acts exceedingly well in those instances where digitalis 
fails, and this is particularly true in children. It will relieve cardiac 
dropsy by its action on the heart, but does not possess marked diuretic 
properties. 

Untoward Effects. — Strophanthus when given in full dose frequently 
causes diarrhoea. 

Administration. — Strophanthus is given in the form of the tincture 
(Tinctura Strophanthi, U. S. and B. P.) in the dose of 3 to 6 drops 
(0.2-0.35) three times a day. Strophanthin may be given hypo- 
dermicallv in the dose of yj-g- to -^ of a grain (0.0006-0.0012). Its 
effects when so used are said to last a week, but this statement can 
scarcely be correct. 

SUGAR. 

Saccharum, U. S. (Saccharum Purificatum, B. P.), is the refined 
juice of Saccharum Officinarum, or Sugar-cane, or the juice obtained 
from the Sugar-beet. It is an antiputrefactive, but not an antifer- 
mentative. Mixed with iron preparations, it prevents oxidation. As 
it is a hydrocarbon, it is a nutrient and a developer of adipose tissue, 



336 DRUGS. 

or, in other words, is a food, Its use is contraindicated in obesity, 
during the existence of fermentative changes in the stomach and 
intestine, and in diabetes mellitus. 



SUGAR OP MILK. 

Saceharum Lactis, U. S. and B. P., is derived from the whey of 
cow's milk by evaporation, in the proportion of about 5 per cent., and 
is then purified by re-crystallization. It has little sweetening power 
compared to cane-sugar and possesses a peculiar flat taste. It is, how- 
ever, less apt to ferment and is better for infants than is cane-sugar. 

Milk-sugar is largely used in triturations, because by its hardness 
it aids in the subdivision of the medicament. It is also used to 
increase the bulk of small powders where such drugs as podophyllin 
and calomel are prescribed. 

Recent studies, both scientific and clinical, have shown lactose to 
be possessed of very great diuretic power when given in full doses. 
The advantage claimed for lactose as a diuretic is its direct action on 
the kidney and the slight effect exercised upon the rest of the organism. 
It is, therefore, in renal dropsy or renal inactivity that this substance 
is particularly indicated. The dose of lactose in cases of dropsy 
should be as great as from 2 to 4 drachms (8.0-16.0), given daily, 
dissolved in a quart (1 litre) of water. It has been found that the 
lactose acts best in those cases in which there is no albuminuria. 
These recent studies are of interest in view of the well-known clin- 
ical fact that the addition of lactose to the milk of bottle-fed babies 
always causes profuse diuresis. 



SULPHATE OP ZINC. 

Zinci Sulphas, U. S. and B. P., is a white, somewhat efflorescent 
salt, of a sharp acid taste, and is soluble in water. In large amounts 
it acts as an irritant, and is employed as an irritant peripheral emetic 
in the dose of 10 to 30 grains (0.65-2.0). It is not so severe as sul- 
phate of copper in its emetic and poisonous properties, and may be 
repeated if the first dose does not produce vomiting. In weak solu- 
tions it may be used as an astringent application by injection in gon- 
orrhoea and other affections of the urethral mucous membrane. In 
2-grain (0.1) pills it is sometimes given in serous diarrhoeas, particu- 
larly if it be combined with opium or minute doses of podophyllin {-^ 
of a grain [0.001] at a dose). In conjunctivitis and other eye affec- 
tions the drug is used in the form of a wash. (See Conjunctivitis.) 



SULPHIDES. 

Baths of the various sulphides, such as those to be obtained at 
sulphur springs, are very useful in many cases of skin disease of an 



SULPHONAL. 337 

obstinate type, such as psoriasis, lichen, and eczema. They are also 
employed in chronic rheumatism and gout. 

In laryngeal hoarseness and pharyngeal affections, such as follow 
public speaking and exposure to cold, sulphides or sulphur-waters are 
very useful, and little doubt exists but that their persistent employ- 
ment is one of the best means to cure the obstinately atonic state of 
the throat sometimes seen in public speakers. 

As was first noted by Dr. Ringer, the sulphides, particularly in 
the form of calx sulphurata, are very useful in all cases where pus is 
about to form. 

They may be employed in cases where successive crops of boils occur, 
and in adenitis of the neck and glandular swellings occurring else- 
where. If they do not stop the formation of pus, they aid in its 
inspissation and absorption. Children should take a teaspoonful (4.0) 
every hour of a solution containing 1 grain (0.05) of calx sulphurata 
to the J pint (250 cc.) of water. Adults may be given sulphide of 
calcium in gelatin-coated pill, dose \ to \ a grain (0.015-0.03) three 
times a day. The solution must be freshly prepared, as it undergoes 
oxidation, changing the drug into a sulphate. 



SULPHOCARBOLATES OP SODIUM AND ZINC. 

The sulphocarbolates of zinc and sodium are largely employed by 
some practitioners as mild antiseptic local stimulants, either in pow- 
der or in solution, on ulcers and sores. Much more commonly they 
are given internally for the production of gastro-intestinal antisepsis 
when there is diarrhoea with foetid, ill-smelling stools, as in the bowel 
disorders of hot weather in children or adults or in the course of 
typhoid fever. How much good they do in the latter disease, so far 
as the disease itself is concerned, is uncertain, but they undoubtedly 
render the stools less foul and tend to check the diarrhoea. The sul- 
phocarbolate of zinc is the better of the two for these purposes. The 
dose is 2 to 3 grains (0.1-0.15) in pill four or five times a day. The 
sulphocarbolates are probably eliminated from the body unchanged. 



SULPHONAL. 

Sulphonal, B. P., is a synthetically prepared substance first manu- 
factured in Germany by Baumann, and possesses the chemical name 
of diethyl-sulphon-dimethyl-methane. It is a colorless, odorless, solid 
substance, soluble in 100 parts of cold and 18 to 20 parts of hot 
water, and is readily soluble in alcohol and ether. The drug is not 
affected by any of the ordinary acids, and is very stable. 

Physiological Action. — Several quite interesting researches upon this 
comparatively new hypnotic have been carried out recently. Smith of 
London has studied its action on the activity of tissue-change, and 
also attempted to determine the changes in the drug during its pas- 
sage through the body. Without taking up space with a full consid- 

22 



338 DRUGS. 

eration of his method of experimentation, we find that his conclusions 
may be summed up as follows : In moderate doses the drug is com- 
pletely changed during its passage through the body into a sulphur- 
etted organic substance, and the elimination of sulphuric acid is not 
increased by taking sulphonal. Dr. Smith does not give us the exact 
nature of the substance derived from sulphonal, but promises to inform 
us further concerning it in a later contribution. Another paper upon 
the physiological action of sulphonal has been published by Dr. Wil- 
liam F. Shick of Easton, Pa., who has found, by a series of experi- 
ments, first, that sulphonal when given by the stomach acts very 
slowly, on account of its insolubility, but that subcutaneously in 
warm solution it is much more active. The drug was also found to 
produce a general relaxation of the muscles, and a staggering gait 
after its hypnotic power had passed by. The spectroscope failed to 
show any changes in the blood. The motor nerves were not affected. 
Shick believes that the action of the drug is exerted upon the higher 
nerve-centres. He also found a decreased reflex activity, and believes 
this lessening to be due to stimulation of Setschenow's reflex inhibi- 
tory centre. On the circulation the drug was found to have but little 
power. When sent directly into the blood there was produced a slight 
decrease in arterial pressure, followed very soon after by an increase. 
Upon the respiration the drug was found to act as a depressant when 
given in full doses. 

Therapeutics. — Sulphonal finds its place in medicine as a somni- 
facient or hypnotic, valuable when functional nervous insomnia is 
present, useless where advanced disease, such as cardiac trouble, is 
responsible for the wakefulness. In insanity it often produces sleep, 
and is of great service in the various mental disturbances character- 
ized by lack of sleep and often affecting persons of unsound mind. 
Sulphonal may be defined very briefly by any one who has largely 
used it or watched the reports made of its progress. This definition 
is that the drug does possess sleep-producing power of moderate 
amount — not equal to chloral or potassium bromide, but greater than 
that of paraldehyde — and that it will sometimes succeed where the 
other hypnotics fail. 

Administration. — Sulphonal being virtually insoluble in cold water, 
it may be given in large capsules or in mucilage of acacia, so as to 
be held in suspension until swallowed. The insolubility and bulki- 
ness of the drug render its use difficult. It is best given in hot water 
(about 6 ounces), as suggested by Stewart. This makes a solution, 
and as soon as the liquid is cool enough to be swallowed it should be 
taken before precipitation occurs as the result of cooling. Sulphonal 
should be used several hours — say two or three — before the patient 
retires. If taken late at night, the patient frequently fails to get to 
sleep until the morning hours. This difficulty is partly avoided by 
the use of a hot solution, but even then is apt to arise. The dose is 
20 to 40 grains (1.3-2.6). 

Untoward Effects. — When sulphonal is taken in full dose for long 
periods of time, great sleepiness and weariness, with an unsteady 
gait, develop, which may go on to paralysis of the lower extremities 



SULPHUR. 339 

if the use of the drug is persisted in. In some cases the paralysis is 
progressive, and in others hyperesthesia and abnormal sensations 
develop. In all such cases there is great disturbance of digestion 
with scanty secretion of urine, which contains an unusual substance, 
giving this secretion the color of port wine. In the author's experi- 
ence sulphonal often produces heaviness and a staggering gait the 
day after it is taken. There are numbers of cases of death on record 
from acute and chronic poisoning by sulphonal. In both classes of 
cases the death was by respiratory failure preceded by deep uncon- 
sciousness. 

SULPHUR. 

Sulphur is a non-metallic element official in three forms in the 
U. S. P. — namely, as Sulphur Sublimatum, or sublimed or flowers 
of sulphur ; Sulphur Prcecipitatum, U. S. and B. P., or precipitated 
sulphur ; and Sulphur Lotum, or washed sulphur. 

Much confusion exists among students as to the differences between 
these various forms of sulphur. Sulphur itself is an element which 
is prepared for medicinal uses by being heated and sublimed {Sulphur 
Sublimatum), or flowers of sulphur. Sulphur lotum, or washed sul- 
phur, is prepared in order to get rid of sulphuric acid and other con- 
taminating substances, and is made from sublimed sulphur. Sulphur 
prgecipitatum is also made from sublimed sulphur, and is more bland 
and minutely subdivided. Some believe it differs from sublimed 
sulphur in its therapeutic properties by reason of a small amount of 
water supposed to be present. It is sometimes called milk of sulphur. 
When sulphur is prescribed for internal use the sublimed sulphur is 
generally designated. 

Physiological Action. — Sulphur has little physiological influence 
over the general system. When taken internally it causes a soft, 
mushy stool of a yellow color with a strong odor of hydrogen sul- 
phide. The drug acts particularly on the skin and mucous membranes. 
The juices of the intestines break up some of it into sulphuretted 
hydrogen and sulphides. 

Therapeutics. — Sulphur is used as a mild laxative, never as a 
purge. In stricture of the bowels the soft stools produced by it will 
often slip by the obstruction, and it is worthy of note that sulphur 
will sometimes overcome constipation when nothing else will give 
relief. It is particularly valuable in the treatment of constipation 
Avhere there are hemorrhoids, and in chronic rheumatism and sciatica 
it is thought by some to effect a cure. 

Sulphur is of great service in the treatment of chronic bronchial 
affections, but for some curious reason its use has become almost obso- 
lete. The so-called Bergeon's method of treating phthisis by rectal 
injections of carbonic acid gas loaded with sulphuretted hydrogen was 
simply a revival of a custom of our great-grandfathers, who often used 
sulphur-waters by the mouth in the treatment of catarrhs or other 
disorders of mucous membranes. Bergeon took the trouble to go to 
the rectum to accomplish what was done two hundred years ago by 



340 DRUGS. 

the mouth, and the only novel part of his method was his filthy way 
of using the remedy. Graves recommended 5 to 10 grains (0.35- 
0.65) of sulphur three times a day wherever bronchial secretion was 
excessive, and found that it rid the lungs of mucus and relieved the 
cough. 

The external use of sulphur is very much more important than its 
internal use, in so far as regards affections of the skin. Of itself, 
the drug exercises little effect over the cuticle when used in powdered 
form, but combination with an ointment makes it at once active. Even 
irritations of the skin may ensue from its constant use in concen- 
trated form. 

In scabies, or itch, sulphur ointment ( Unguentum Sulphuris, U. S. 
and B. P.) is the best remedy Ave have. The female parasite burrows 
under the epiderm and deposits the ova as she moves about, while the 
male does not burrow, but stays on the surface. The ointment will 
kill him, as he is readily attacked, but the female is protected by her 
burrowing propensities. To get at her and the ova the burrows must 
be opened, and this may be accomplished by a thorough soaking of 
the body with soap and water, thereby softening the epiderm covering 
the parasite, which can then readily be removed by rubbing the 
patient with a rough towel. The towel should be boiled at once to> 
prevent its conveying the parasite to others. The ointment, if now 
applied, relieves the patient almost at once. It is important that the 
skin be well softened and rubbed, in order to keep open every burrow. 
The ointment should be allowed to remain on the part all night and 
be used for three or four nights consecutively. 

Young women often suffer from acne, particularly about the men- 
strual epoch, the skin also becoming at this time sallow and muddy. 
Ringer recommends the following lotion as one which is very success- 
ful in promoting a cure : 

R. — Sulphuris sublimati £j (4.0). 

Glycerini f&j (4.0). 

Aqupe ros?e f £viij (256.0). — M. 

S. — Apply as a wash once or twice daily. 

Administration. — Sulphur is given in the dose of 10 to 20 grains 
(0.65-1.3) three times a day as an alterative, and from 1 to 2 drachms 
(4.0-8.0) at night as a laxative, with a little molasses to form a paste. 

A confection (Confectio Sulphuris) is official in the B. P., dose 10 
grains to 2 drachms (0.65-8.0). 

Sulphide of Calcium. 
(See Calcium, Calx, and Sulphides.) 



SULPHURIC ACID. 

Acidum Sulphuricum, U. S. and B. P., Sulphuric Acid, or Oil 
of Vitriol, is a powerful irritant and escharotic, rapidly dehydrating 
and carbonizing the tissues, causing them to become black. It is the 



SUMBTJL. 341 

most astringent of the mineral acids, and when absorbed is converted 
into sulphates, and so eliminated by the kidneys, the lower bowel, and 
the skin. 

Poisoning. — The symptoms produced by poisonous doses are those 
of a gastro-intestinal inflammation of the most severe type, or the 
patient may drop to the floor almost at once, OAving to . collapse 
dependent upon perforation of the walls of the oesophagus or stomach 
by the acid and its consequent escape into the peritoneal cavity. If 
the patient lives to the fourth day, the parotid glands may become 
swollen as the result of stenosis of the salivary ducts of Steno, and 
violent inflammation of the kidneys may appear from the passage of 
the drug through these organs in the process of elimination. If par- 
tial recovery takes place, the patient often dies from inanition due to 
the formation of strictures in the alimentary canal or to destruction 
of the peptic tubules. The stain about the mouth is black, and if 
any of the acid is spilt on the clothes the characteristic burn is to 
be seen. 

The treatment consists in the use of alkalies, such as chalk, mag- 
nesium, whitewash off the walls, and soap. Opium and oils are to 
be given to allay irritation, and external heat is to be applied. 

Therapeutics. — Sulphuric acid is sometimes employed as a caustic 
to venereal sores, warts, and slowly -healing ulcers, but is most com- 
monly used internally, as it fulfils several pressing indications. As 
a remedy for serous diarrhoea, particularly if combined with some 
vegetable astringent, it is unsurpassed, and its use in cholera deserves 
great attention. (See Diarrhoea.) In the Philadelphia Hospital dur- 
ing an epidemic of cholera some years since every case which 
received it improved or failed to be attacked, whereas those who did 
not receive it were either very ill or died. 

The proper way to use the drug as a prophylactic during cholera 
epidemics is in the form of "sulphuric-acid lemonade," made so that 
each wineglassful of water contains 5 drops (0.35) of the aromatic 
sulphuric acid. The same solution may be used in acute lead poison- 
ing in order to form an insoluble sulphate of lead, and may be taken 
by artisans exposed to chronic lead poisoning as a prophylactic for 
the same reason. 

As sulphuric acid is eliminated by the skin, it is often useful in 
the night-sweats of phthisis combined with belladonna or morphine. 

Administration. — The dose of the dilute acid {Acidum Sulphur icum 
Dilution, U. S. and B. P.) is 10 to 20 drops (0.65-1.3), and of the 
aromatic acid [Acidum Sulphuricum Aromaticum, TJ. S. and B. P.) 
5 to 20 drops (0.35-1.3). The latter is the best preparation for gen- 
eral use. It contains ginger and oil of cinnamon. Both should be 
thoroughly diluted before they are administered. 



SUMBUL. 

Sumbul, TJ. S., is the root of Ferula Sumbul, a large plant of 
Northern Asia. The dose of the root [Sumbul Radix, B. P.) is 10 



342 DRUGS. 

to 40 grains (0.65-2.65), On the nervous system sumbul acts as an 
efficient nerve tonic, and is very largely employed by Goodell in cases 
of nervous exhaustion and in the unrest of nervous females. It is 
official in the tincture (Tinctura Sumbul, U. S. and B. P.), dose 1 to 
4 drachms (4.0-16.0). Goodell uses the folloAving formula: 

R. — Extract, sumbul gr. xx (1.3). 

Ferri sulph. exsiccat gr. xx (1.3). 

Asafoetidae gr. x (0.65). 

Acid, arsenosi gr. J (0.03). — M. 

Ft. in pil. No. xx. 
S. — One t. d. after meals. 

To be of any value the drug must be fresh, and care must be taken 
that the crude drug from which it is made is a good sample. 



SWEET SPIRIT OF NITRE. 

Sweet Spirit of Nitre (Spiritus JEiheris Nitrosi, U. S. and B. P.), 
or Spirit of Nitrous Ether, is a mixture of alcohol, water, and ethyl 
nitrite. It is upon this last constituent that most of its value as a 
remedial agent depends. The drug when sold by pharmacists or 
others who are not very careful to keep fresh preparations is no better 
than alcohol and water alone, since the ethyl nitrite readily escapes, 
and deterioration at once takes place. Until recently the profession 
have had no ready means of protecting themselves from such poor 
preparations, but at present we know that all that is necessary is to 
add a grain or two of antipyrine to a J ounce or less of the spirit. If 
the ethyl nitrite be present, a purple color followed by a green pre- 
cipitate will be found. This green precipitate is iso-nitroso-anti- 
pyrine, which is not in the least poisonous. 

Physiological Action. — Sweet spirit of nitre is a sedative to the cir- 
culatory and nervous system and a diaphoretic and diuretic, accord- 
ing to the manner in which it is administered. 

If given in very full doses, it rapidly produces the cyanosis cha- 
racteristic of the full effects of any one of the nitrites. (See Amyl 
Nitrite.) 

Therapeutics. — There is probably no drug so widely employed by 
the laity as a household remedy which is so potent for good, and yet 
so harmless, if wrongly used, as is this one. 

Physicians often place less reliance upon it than it deserves, and 
in nearly every instance where it fails it is either not indicated or the 
nitrite has escaped and left it powerless. 

In incontinence of urine in children the combination which follows 
is very useful in certain cases. (See Incontinence of Urine.) In these 
instances the urine will be found high-colored and concentrated, and 
therefore capable of irritating the bladder and genito-urinary tract: 

R.— Potassii citratis 3j to ^ij (4.0-8.0). 

Spt. setheris nitrosi , f?ss (16.0). 

Aqute q. s. ad f=iv (128.0).— M. 

S. — Dessertspoonful (8.0) every five hours until the urine becomes clear. 



TANNIC ACID. 343 

As soon as the urine is clear, belladonna may be used, the citrate 
of potassium and spirit of nitre being continued or not as the case 
demands. Where the spinal centres are depressed and there is gen- 
eral atony of the system, it may be well to substitute the following 
pill for the belladonna : 

R. — Acid, arsenosi gr. | (0.016). 

Extract, nucis vomicae ........ gr. ij (0.1). 

Quininse sulphatis - . . . . gr. xx (1.3). — M. 

Ft. in pil. No. xx. 
S. — One pill t. d. after meals. 

The diuretic action of sweet spirit of nitre is best obtained by 
using the drug in ice-cold water and keeping the patient lightly cov- 
ered and cool. On the other hand, if a diaphoretic influence is 
desired, it may be given simultaneously with warm lemonade, and 
the patient should be well blanketed. This last action of sweet spirit 
of nitre has made it a remedy of common use in treating acute colds 
in adults and children, and in setting aside the fever of these condi- 
tions in the latter class as well. 

Sweet spirit of nitre is a distinct antispasmodic, and can be well 
employed where slight nervous excitement accompanies fevers or in 
other states associated with irritation in infancy. 

The dose for an adult is from 20 drops to 1 drachm (1.3-4.0), and 
for a child of one year 5 to 10 drops (0.35-0.65). It should always 
be given in cool water to the latter class of patients. 



TAMARINDS. 

Tamarindus, U. S. and B. P., is the preserved pulp of Tamarindus 
Indica, a tree of the West Indies. 

The taste is a peculiar mixture of bitter and sweet. As a laxative 
it exerts little power over that of any ordinary fruits, such as apples, 
but it enters into the confection of senna (Confectio Senna?, JJ. S. 
and B. P.). Patients often find tamarinds a very agreeable laxative 
when they are taken before going to bed or eaten as a confection after 
meals. 



TANNIC ACID. 

This acid when pure is an uncrystallizable, white or yellowish- 
white powder without bitter taste and very soluble in water or glyce- 
rin. It is not so soluble in alcohol and ether. It is the chief active 
principle of vegetable astringents, and occupies the relative position 
of an alkaloid to a crude drug, so far as the active portion of these 
vegetable astringents is concerned. Tannic acid is derived from nut- 
gall. 

Physiological Action. — Tannic acid when brought in contact with 
any of the tissues of the body constringes them and decreases their 
vascularity for a tiine, by causing contraction of their blood-vessels. 



344 DRUGS. 

For these reasons it stops secretion and condenses parts of the body 
which are relaxed and feeble. Mixed with blood, it forms a clot with 
great rapidity through coagulation of the albumin. Tannic acid is 
absorbed as gallic acid and eliminated as such, only acting as tannic 
acid before absorption. This is important to remember, since we 
learn from this that tannic acid is to be used to check hemorrhage 
only where the drug can be brought in direct contact with the bleed- 
ing point. If a hemorrhage is to be reached through the circulation, 
as in renal bleeding, gallic acid is to be given, as it is absorbed at 
once without change. 

Therapeutics. — Tannic acid is used in medicine to control hemor- 
rhage, and to act as an astringent to relaxed tissues, as in diarrhoea 
of the atonic or serous type, or in localized or general siv eating. It 
is also of service for the purposes of toughening mucous membranes 
or parts of the skin which are exposed to much rubbing, as in the 
case of the nipples of a primipara, or where the feet become mace- 
rated and sore or sweat profusely on exercise being taken. In the 
treatment of haemoptysis tannic acid may be dissolved in water in the 
proportion of 5 to 10 grains (0.35-0.65) to the ounce (32.0) and used 
as a fine spray. Glycerite of tannin is made by adding 2 ounces 
(64.0) of tannic acid to a J pint (250 cc.) of glycerin, and mixing at 
a gentle heat until solution occurs. It is useful as an application to 
slow ulcers and depressed mucous membranes, as after an attack of 
stomatitis. In hemorrhoids of the bleeding type tannic-acid supposi- 
tories are often very useful, and cotton saturated with tannic-acid 
solution is often used as a packing in vaginal leucorrhoea. 

Administration. — The dose of tannic acid is 2 to 10 grains (0.1- 
0.65), best given in pill. The official preparations are — the troches 
{Trochisci Acidi Tannici, TJ. $.), each containing 1 grain of tannin 
the Glyceritum Acidi Tannici, TJ. S. ; Collodium Stypticum, TJ. S. 
and an ointment (Unguentum Acidi Tannici, TJ. S.). The B. P 
preparations are — Glyceritum Acidi Tannici; Suppositoria Acidi 
Tannici, each containing 3 grains (0.15); and Trochisci Acidi Tan- 
nici, of which each contains J grain (0.03) of the acid. 



TANSY. 

Tansy {Tanacetum, TJ. S.). The leaves and tops of Tanacetum 
Vidyare yield a volatile oil {Oleum Tanacetum) which possesses 
emmenagogue powers and has been largely used as a uterine stimu- 
lant. It is also used as an anthelmintic. 

In poisonous dose it causes epileptiform convulsions in some cases, 
and deep coma, with death from respiratory failure. 

The dose of the oil as an emmenagogue is 1 to 3 drops (0.05- 
0.15). 

In domestic medicine tansy tea, made by adding 1 ounce (32.0) of 
the leaves or tops to 1 pint (J litre) of water, and given in the dose 
of 1 to 2 ounces (32.0-64.0), is largely employed as a remedy for 
amenorrhoea. 



TEREBENE. 345 

TAR. 
(See p. 303.) 

TARAXACUM. 

Taraxacum, TJ. S., Dandelion, is a very old remedy for hepatic 
torpor and the dyspepsia resulting therefrom. It should be prepared 
from the fresh leaves or roots, as the dried, stale plant is inert, From 
-disregard of this fact much disappointment has arisen. Owing to its 
being bitter it acts as a tonic. The extract (Extr actum Taraxaci, 
TJ. S. and B. P.), dose 5 to 30 grains (0.35-2.0), and the fluid 
extract (Extractum Taraxaci Fluidum, TJ. S.), dose 1 to 3 drachms 
(4.0-12.0), are the only official preparations. Succus Taraxaci, 
B. P., is given in the dose of 1 to 2 drachms (4.0-8.0); Decoc- 
tum Taraxaci, B. P., is administered in the dose of 2 to 4 ounces 
(64.0-128.0). 

TARTARIC ACID. 

Acidum Tartaricum, TJ. S. and B. P., is derived from crude 
potassium bitartrate, and is much less powerful than acetic acid, but 
capable of producing very severe gastro-enteritis if taken in overdose 
and in concentrated form. It is rarely used alone, and is most com- 
monly employed to act upon sodium or potassium bicarbonate to form 
effervescent drinks. (See Seidlitz Powder and Effervescing Draughts.) 
The dose is 5 to 20 grains (0.35-1.3). 

When tartaric acid is taken in poisonous dose, lime-water, alkalies, 
and magnesium are the antidotes, and opium is to be given to allay 
irritation. If necessary, emetics are to be used. 



TEREBENE. 

Terebenum, TJ. S., is a liquid substance, clear, colorless, insoluble 
in water, having a peculiar odor like that of new T pine sawdust, and 
is made by the action of sulphuric acid upon oil of turpentine, which 
is then distilled at about 160° F. 

Therapeutics. — Terebene is a very useful stimulating expectorant, 
to be used in the late stages of acute or in chronic bronchitis to liquefy 
and get rid of the mucus w T hich is clogging the bronchial tubes. The 
drug may be given by way of the stomach or by inhalation. A useful 
mixture in the later stages of bronchitis when the mucus is very thick 
and tenacious is one composed of equal parts of terebene, iodide of 
ethyl, and chloroform, placed on a sponge and held some tw T o or three 
inches from the face. It has also been employed in genito-urinary 
inflammations of a subacute or chronic form in place of oil of sandal- 
wood or copaiba as a stimulant. In fermentative dyspepsia it is of 
service as an antiseptic. The drug should always be given in cap- 



346 DRUGS. 

sules in the dose of 5 to 10 minims (0.35-0.65), or by dropping it on 
sugar in the same amount. This dose may be repeated every three 
hours. Unfortunately, terebene is very apt to irritate the stomach or 
to produce diarrhoea, and it sometimes irritates the kidneys. 



TERPINE HYDRATE. 

Terpine Hydrate {Terpini Hydras, U. S.) is prepared by a certain 
process, unnecessary to explain, from a mixture of pure oil of tur- 
pentine, alcohol, and nitric acid. In this manner large, colorless crys- 
tals, without odor and with a faint taste, are formed, and in this form 
the drug appears on the market. Terpine hydrate is soluble in 250 
parts of cold, 32 parts of boiling water, and in 10 parts of alcohol. 
In ether it requires 100 parts for its solution, and in chloroform 200 
parts. 

Therapeutics. — Terpine hydrate is used for the purpose of increas- 
ing secretion from the bronchial mucous membrane, and is a useful 
remedy in subacute or chronic bronchitis to rid the tubes of mucus. 
The drug has also been satisfactorily employed in the treatment of 
hay fever when given in full doses. The remedy, while only useful 
in a limited number of conditions, certainly seems to be very useful 
in the varieties of diseases named. The dose as generally given is 2 
to 3 grains (0.1-0.15), but it may be given in the dose of 15 to 20 
grains (1.0-1.3) three times a day in hay fever. Terpine hydrate may 
be prescribed in pills, capsules, and in alcoholic solution flavored with 
some of the aromatic waters and with the addition of a little syrup. 



TERPINOL. 

Terpinol is derived from terpine hydrate by boiling the latter with 
dilute mineral acids. Terpinol occurs as an oily substance smelling 
like hyacinths. It is almost insoluble in water, but dissolves readily 
in ether and alcohol. It is used for precisely the same purposes as 
terpine hydrate, in the dose of 8 to 20 grains (0.5-1.3), in capsules 
or pills. This dose may be given twice or thrice a day. The drug 
may irritate the stomach and kidneys when given in overdose. 



THAPSIA. 

Thapsia G-arganica is an umbelliferous plant of South-eastern 
Europe, employed for the purpose of producing a blister. It is gen- 
erally used under these circumstances in the form of a plaster. The 
resin, obtained from the bark of the root, is the form in which it 
appears in medicine. When applied continuously it produces great 
irritation, and finally sloughs appear. 



THYMOL. 347 



THIOL. 



Thiol is a substance introduced into medicine as a substitute for 
ichthyol, as the latter drug possesses the disadvantage of having a 
disagreeable odor. It is derived from brown-colored paraffin or gas 
oils by a complicated process. The product obtained is evaporated in 
vacuo to a thin extract called Thiolum Liquidum, or still further to dry- 
ness, or Thiolum Sicca. The liquid thiol occurs as a thin brownish- 
black neutral fluid, smelling somewhat like birch oil. It is slightly 
soluble in alcohol and ether, but quite soluble in water, forming a 
clear mixture, which is rendered more perfect by the addition of 
glycerin. Thiol sicca may appear in lustrous scales. 

Therapeutics. — The question which arises at once in regard to thiol 
is, whether the fact that thiol is practically an artificial ichthyol 
necessarily indicates that it can be used as a substitute for that sub- 
stance ? While it is true that they are both sulphur compounds, it is 
also true that ichthyol possesses very extraordinary powers not met 
with in any other form of sulphur compound previously known. Thiol 
has been used largely by skilful observers in diseases of the skin in 
moist eczema, scrofulosis of the skin, and in syphilidek ? with asserted good 
results. In cases of moist eczema the thiol is used, after first wash- 
ing the part with an antiseptic solution, if it is dusted over the skin 
in the form of powder. Bidder has treated the disease by using com- 
presses wet with thiol in 10 per cent, solution. 

While it is claimed that thiol will relieve exudations about joints 
and elsewhere in as effective a manner as ichthyol, sufficient evidence 
as to this point is not yet before us. Thiol is much cheaper than 
ichthyol. 

THYMOL. 

Thymol, U. S. and B. P., is derived from the oil of thyme and 
other volatile oils, and occurs in large crystals. It is almost insoluble 
in water, but is freely soluble in fats and oils. Thymol is irritant, 
but antiseptic and disinfectant, and has been employed in typhoid 
fever as an intestinal antiseptic by Henry and others. Under these 
conditions it should be used in gelatin-coated pill, and a glass of 
water or milk taken to avoid the burning sensation. In the treat- 
ment of stomatitis or tenderness of the gums after mercurialization 
the following mouth-wash may be used : 

R— Thymol gr. x (0.65). 

Sodii boratis . gr. xv (1.0). 

Aqua; f$ij (64.0).— M. 

S. — Place a teaspoonful (4.0) of this in J a tumblerful of water and use as a gargle. 

Thymol has been used for dressing wounds, but is too costly. In 
summer weather it cannot be employed, because of its power of attract- 
ing flies, which make the patient's life miserable. The dose is \ to 2 
grains (0.03-0.1), in capsule or in wafer, and it is better to follow its 
use by a glass of milk to prevent the drug from irritating the stomach. 



348 DRUGS. 

In typhoid fever as much as 30 grains (2.0) in twenty-four hours may 
be given. 

If very large amounts (100 grains [7.0]) are taken in a clay, poi- 
soning may result, but as much as this must be used before danger is 
present. 

Thymol Iodide. 

This compound of iodine and thymol, sometimes called aristol, but 
more correctly dithymol diiodide, has been introduced into medicine 
for the purpose of substituting iodoform. It does not possess the 
unpleasant odor of iodoform, and it is stated to be less apt to produce 
poisoning by absorption. A great deal of contradictory experience 
has accumulated as to its exact value, but the result of a careful 
examination of clinical reports is that in some respects it is a better 
drug than iodoform and in others not so good. Tichhoff and Neisser 
state that when taken internally thymol iodide is incapable of causing 
toxaemia, but this can only be true when moderately large closes are 
given. Upon cocci and bacilli thymol iodide has less power than 
iodoform. In regard to the power of this drug in healing wounds 
or sores, the decision has been reached that whenever secretion is free 
it is contrainclicated, as the thymol seems to increase moisture. On 
the other hand, in those instances where in disease of the skin or 
mucous membrane an undue dryness is present the effect produced is 
often favorable. Upon lupus little effect is produced unless the sur- 
face is first curetted. Finely-powdered thymol iodide has been found 
of very unusual value in the treatment of interstitial keratitis by de 
Schweinitz and Wallace when dusted into the eye each day. In an 
ointment of \ to 1 drachm to the ounce of lard (2.0-4.0 : 32.0) thy- 
mol iodide may be used in psoriasis, but it is not as useful as is 
chrysarobin in this affection. 



TOBACCO. 

Tabacum, U. S. (Tabacum Folia, B. P.), is the dried leaves of 
Nicotiana Tabacum, a native of tropical America, but cultivated all 
over the temperate zone. It contains a liquid alkaloid, nicotine, but 
does not contain nicotianin, as no such principle exists. 1 When 
smoked it yields pyridine, Avhich is sometimes used in medicine by 
itself. 

Physiological Action Tobacco in overdose is a nauseating emetic, 

very depressant in its influence on respiration and the circulation. 
The pupils are contracted by its influence, the bodily temperature is 
lowered, and the skin becomes cold and clammy. 

Upon the motor nerves tobacco acts as a depressant poison. 

Nicotine is one of the most violent poisons known, and is almost 
as fatal as hydrocyanic acid, death having taken place in three minutes 
after the ingestion of a poisonous amount. 

The drug, when smoked or chewed to any extent by young per- 

1 See author's Prize Essay on Tobacco. Philadelphia, 1885. 



TRIONAL AND TETRONAL. 349 

sons, stunts the growth of all parts of the body, and is very apt to 
cause in all persons granular sore throat, pharyngitis, laryngitis, and 
faucitis. Sometimes angina pectoris is developed. " Tobacco heart" 
is a term applied to a condition of this viscus characterized by disor- 
ders in its rhythm or power, palpitation, arhythmia, and dyspnoea 
often being present. 

The treatment of poisoning by tobacco consists in the use of strych- 
nine to stimulate the nervous system and the respiratory centre, and 
in the employment of cardiac stimulants, external heat, and atropine. 

TRICHLORACETIC ACID. 

Trichloracetic Acid is a compound of chlorine and acetic acid 
occurring in deliquescent crystals and used as a rapid, active eschar- 
otic upon venereal and other warts. A peculiarity in its effect is that 
it produces a dry scab which speedily falls off, leaving a healing surface 
beneath. It is also claimed that its action is not followed by secondary 
inflammation and pain. It is used by applying a crystal to the wart 
or other growth. 

TRIKRESOL. 

Trikresol consists in a combination of ortho-, meta-, and paracresol, 
bodies allied to creolin and carbolic acid. Trikresol appears in com- 
merce as a white liquid, smelling somewhat like creosote, and soluble 
in water in the proportion of about 2^ per cent. It forms a clear 
solution, and does not benumb the skin as does carbolic acid. It is 
also much less irritant and less poisonous than carbolic acid or bichlo- 
ride of mercury. 

Therapeutics. — Trikresol is used as an antiseptic in surgery in 1 
per cent, solutions. In the strength of 1 : 500 to 1 : 1000 it may be 
employed as an antiseptic collvrium in ophthalmic practice, in which 
field it has proved very useful. 

TRIONAL AND TETRONAL. 

These two substances are very closely related to sulphonal, and 
are practically identical with that drug in their effects on the general 
system. They occur in shining, odorless, colorless plates with a very 
faint taste. Trional and tetronal are used for the relief of insomnia 
of a functional type, and the sleep produced by these ordinarily comes 
on in about twenty to thirty minutes after the drug is taken, and lasts 
five to six hours. The dose is 15 to 30 grains (1.0-2.0). Trional and 
tetronal are slightly soluble in water and very soluble in alcohol. 
Advantages in their use are lack of disagreeable taste and the absence 
of symptoms of circulatory depression. The best way to administer 
trional or tetronal is in hot broth or tea or whiskey. It is wise to 
gradually decrease the dose if the drug is taken night after night. 
Tetronal is more expensive than trional, but sometimes succeeds when 
trional fails. 

When trional is taken in full dose for several weeks, it pro- 
duces very distinct alterations in the blood, which are manifested 



350 DRUGS. 

by hsematoporphrynuria — a state in which the urine is dark red or 
almost black. The drug should be stopped at once when the urine 
begins to be red. 

TURPENTINE. 

Terebinthina, U. S., occurs in two forms — namely, as turpentine 
derived from the ordinary yellow r pine (Pinus Palustris) and other 
varieties of pine, and as Canada turpentine (Terebinthina Canadensis, 
U. S.) derived from Abies Balsamea, or silver fir, or species of cone- 
bearing trees other than Pinus Palustris. The turpentine derived 
from the latter sources is sometimes called "Balm of Gilead." 

Much confusion often exists in students' minds as to the difference 
between oil of turpentine {Oleum Terebinthince, U. S. and R. P.) and 
spirit of turpentine, both of which are the same substance under a 
different name. This oil is not, however, the same thing as " tur- 
pentine," for the oil is distilled from turpentine. The distilled oil 
is a thin, clear fluid having a peculiar odor and taste, and is irritant 
to the skin and mucous membranes. It is exceedingly inflammable, 
should never be placed near a light, and if added to any strong min- 
eral acid takes fire. 

When turpentine is spoken of in this book or in medicine gen- 
erally, the doubly distilled oil of turpentine (Oleum Terebinthinos 
Rectificatum, U. &.) is what is meant unless the contrary is stated. 

Physiological Action. — Turpentine when taken internally produces 
a sense of warmth in the stomach, a quickened pulse, a warm skin, 
and slightly accelerated breathing. In overdose it may cause intoxi- 
cation. Upon the circulation it produces a very slight rise of arterial 
pressure, increased pulse-rate, and increased heart-force. On the 
nervous system the drug, in large amounts, causes loss of sensation 
before voluntary motion. 

The drug is eliminated by the kidneys and lungs, and gives the 
odor of violets to the urine. 

Poisonous doses cause strangury, bloody urine, renal inflammation, 
and cyanosis, with dilated pupils and gastro-enteritis. 

Therapeutics. — Exteknal Use. — Turpentine is used as a local 
application for the purpose of producing counter-irritation over any 
area where deep-seated inflammation exists. Under these circum- 
stances it is almost always used in the form of a stupe, made as fol- 
lows : Place a tin cup containing the turpentine in a vessel containing 
hot water, so that the turpentine may be warmed without coming near 
a flame. Dip a piece of flannel into very hot water and wring it out 
in a twisted towel, and, when it is so dry that no water drips from it, 
dip it into the hot turpentine and wring it out again to free it from 
any excess of the drug. The cloth, while hot, should be applied, and 
allowed to remain until discomfort ensues, when it should be with- 
drawn, as it will blister the skin if left on too long. In children and 
adults turpentine may be rubbed on the chest in bronchitis with much 
relief, but in the former class it should be diluted with sweet oil, half 
and half, or even two-thirds of oil. 



TURPENTINE. 351 

Internal Use. — Turpentine is used internally as a stimulant of 
a diffusible type in the course of the exhausting fevers, particularly 
if any flatulence exists or if any ulceration of the botvels is present. 
In typhoid fever turpentine stupes, turpentine enemata, and the 
administration of the drug by the mouth are the best ways to over- 
come tympanites. At the end of the second week, when the tongue 
is reel, dry, cracked, and brown, the teeth covered with sordes, and 
tympany is well marked, turpentine should be used in emulsion in the 
dose of 5 to 10 drops (0.3-0,65) three times a day. Again, in con- 
valescence from typhoid fever, when diarrhoea is persistent and 
relapses are constant and due to an unhealed state of Peyer's 
patches, turpentine is the remedy par excellence. 

In intestinal and other passive hemorrhages such as monorrhagia 
or hematuria, the drug is often of service. 

Used against the tape-ivorm, turpentine is given in the dose of \ an 
ounce to 1 ounce (16.0-32.0), mixed with an equal amount of castor oil. 
This treatment is a somewhat dangerous practice, but is efficient. In 
chronic and well-advanced kidney disease very large doses of power- 
ful diuretics are often required to stimulate the kidneys sufficiently 
to cause urinary flow, and turpentine may be used under these cir- 
cumstances. 

Turpentine is contrainclicated in any acute inflammation of the 
g astro-intestinal tract and in acute nephritis. 

In lumbago the dose of 20 drops (1.3) is said to be very useful, and 
many have found it of value when inhaled from boiling water in bron- 
chitis of a subacute or chronic form. In gleet it is given by the mouth 
to stimulate the genito-urinary tract. Turpentine should be tried in 
the treatment of purpura hemorrhagica, as it has been found of value. 

Administration. — Turpentine may be given for the relief of flatu- 
lence by placing 5 drops (0.3) on a piece of sugar, or in emulsion 
made by using acacia and a flavoring substance, as follows : 

R. — Ol. cinnamomi gtt. xx (1.3). 

01. terebinthinsB f^iv (16.0). 

Mucil. acacise q. s. ad f^iv (128.0). — M. 

S. — A teaspoonful (4.0) every four hours in typhoid fever. 

A more agreeable preparation, not to be used in typhoid fever, is 
that recommended by Bartholow, as follows : 

R .— Olei terebinthinse f£j (4.0). 

Olei amygdal. expres f^ss (16.0). 

Tincturas opii f^ij (8.0). 

Mucil. acacise f^v (20.0). 

Aquye lanro-cerasi f5ss (16.0). — M. 

S. — A teaspoonful (4.0) every four hours for tympanites. 

When used as an enema the following is useful : 

R .— Olei terebinthinEe f.^j (32.0). 

Olei oliva? fSjss (48.0). 

Camphorae ,er. xx (1.3). 

Mucil. acacia? f^ss (16.0). 

Aqua; f^x (320.0).— M. 

S. — To be injected as an enema for the relief of tympanites and to aid in the removal 
of hardened faeces. Stir thoroughly before using. 



352 DRUGS. 

The Liniment of Turpentine (Linimentum TerebintMnce, U. S. 
and B. P.) is largely used as a stimulating application to sprains and 
enlarged joints. 

Turpentine is of service in ringworm, applied with a brush to the 
part affected. The following preparations are official in the B. P. : 
Confectio TerebintMnce, dose 1 to 2 drachms (4.0-8.0); Enema Tere- 
bintMnce, Unguentum TerebintMnce, and Linimentum TerebintMnce 
Aceticum. 

The ointment is used as a counter-irritant and stimulant to the 
part to which it is applied. The liniment acts in the same way when 
applied to sprains and bruises. 



UVA URSI. 

Uva Ursi, U. S., Bearberry, is the leaves of Arctostaphylos Uva 
Ursi, a widely-distributed evergreen shrub. The drug is knpwn in 
the B. P. as Uvce Ursi Folia. Its active principle is arbutin, some- 
times called ursin. 

Therapeutics. — Uva ursi is employed in medicine as a weak, astrin- 
gent diuretic, possessing alterative power over the genito-urinary appa- 
ratus. It is used in pyelitis, cystitis, and in chronic gonorrhoea or 
gleet. When taken in overdose it escapes from the body as hydro- 
chinone, making the urine dark-colored or black. 

Administration. — Arbutin itself is often used in the close of 3 to 5 
grains (0.15-0.35). The dose of the extract {Extractum Uvce Ursi, 
U. S.) is 1 to 4 grains (0.05-0.2), of the fluid extract {Extractum 
Uvce Ursi Fluidum, U. S.) is 2 to 4 drachms (8.0-16.0) three times 
a day. An infusion {Infusum Uvce Ursi) is official in the B. P. y 
dose 1 to 2 ounces (32.0-64.0). 



VALERIAN. 

Valerian {Valeriana, U. S.) is the rhizome and rootlet of Vale- 
riana Officinalis, a plant of Europe, but cultivated in America. It 
is official in the B. P. as Valeriana RMzoma. Its active principle 
is apparently a volatile oil {Oleum Valeriana?, U. S.). It also con- 
tains valerianic acid. 

Physiological Action. — Valerian is a very feeble depressant to the 
nervous system, tending to produce nervous rest, but in cats it excites 
sexual activity to a great degree, probably from its odor. When very 
large doses are given to man, it causes a sense of warmth in the 
stomach, a slightly quickened pulse, and perhaps nausea and vomit- 
ing. Still larger amounts produce purging and mental hebetude. 

Therapeutics. — Valerian is used alone or in combination with other 
drugs to quiet nervous females and to relieve nervousness and insom- 
nia. In Mjsteria it is often very serviceable, and, combined with 
morphine, is much used in the treatment of delirium tremens. 

Administration. — The fluid extract {Extractum Valeriana? Fluidum, 



VEBATRINA. 353 

U. #.), dose 1 fluidrachm (4.0), and the ammoniated tincture (Tinc- 
tura Valerianae Ammoniata, II. S. and B. P.), dose 1 to 3 drachms 
(4.0-12.0), are the best preparations for ordinary use. The infusion, 
which is not official, is given in the dose of a wineglassful, while that 
of the simple tincture (Tinctura Valerianae, U. S. and B. P.) is 1 to 
3 drachms (4.0-12.0). The dose of the oil (Oleum Valeriana?) is 2 
to 4 drops (0.05-0.2). An infusion (Infusum Valeriana?) is official 
in the B. P. in the dose of 1 to 2 ounces (32.0-64.0). 



VALERIANIC ACID. 

Acidum Valerianicum is an oily, colorless liquid of a strong odor 
and burning taste, but is not employed in medicine except in the form 
of its salts, such as the valerianate of zinc, iron, quinine, or ammo- 
nium, all of which are employed, partly for their sedative effects and 
partly for their influence as tonics. 

The dose of Zinci Valerianae is \ to 3 grains (0.03-0.15), that 
of Quininae Valerianae, U. S., 1 to 3 grains (0.05-0.15), of Ferri 
Valerianae 2 to 10 grains (0.1-0.65), and of Ammonii Valerianae 
2 to 10 grains (0.1-0.65). Under the name of " the pill of the three 
valerianates " Goodell recommends the following in nervousness and 
hysteria : 

R. — Quininae valerianat. ~\ 

Ferri valerianat. j- * aa 9j (1.3). — M. 

Amnion, valerianat. J 
Ft, in pil. No. jx. 
S. — One or two three times a day. 



VERATRINA. 

Veratrina, U. S. and B. P., is an alkaloid derived from Veratrum 
Sabadilla, and occurs in a grayish powder, which, if it enters the nose, 
produces violent sneezing which lasts for hours. 

Physiological Action. — Nervous System. — Veratrine has little 
effect on the cerebrum, but it does excite the spinal cord and the 
voluntary muscles, thereby giving rise to tetanic or tonic convulsions, 
which are never clonic or epileptoid. The dominant action of the 
drug is paralytic, and the nervous symptoms just named soon give 
place to paralysis. The muscles lose their contractile power and the 
nervous centres are depressed. 

Circulation. — In poisonous dose the heart is slowed by the drug, 
greatly weakened, and finally stopped in diastole, and is found after 
death to be soft and flabby. In smaller doses it at first slows the 
pulse by stimulating the peripheral inhibitory nerves and the centres 
in the medulla, but later these parts are paralyzed. It first stimulates 
the vasomotor centre, then paralyzes it. 

Respiration. — The drug kills by failure of respiration, due to 
paralysis of the respiratory centres. 

23 



354 DRUGS. 

Temperature. — Veratrine always causes a fall of bodily heat. 

Poisoning. — The symptoms of poisoning in man are collapse, a 
pale, cold, wet skin, pinched features, and a rapid, thready pulse, 
accompanied by violent vomiting and muscular tremors. Tetanic 
convulsions may come on and resemble those of strychnine in that 
they arise from the slightest touch or draught of air ; after death the 
muscles will be found to have lost their irritability. 

Therapeutics. — Veratrine is never used internally. It is employed 
chiefly in the form of an ointment rubbed into the skin over muscular 
rheumatism and rheumatic joints and over neuralgic nerves. The 
official ointment (TJnguerdum Veratrinw, U. S. and B. P.) or the 
oleate {Oleatum Veratrince, TJ. S.) should be used, the latter most 
carefully, as absorption of the drug may take place in sufficient 
quantity to poison the patient. 



VBRATRUM VIRIDE. 

Veratrum Viride, U. S., Indian Poke, Poke-root, or Swamp 
Hellebore, is an American plant largely used for the purpose of 
allaying inflammation ; it is official in the B. P. under the name of 
Veratri Viridis Rhizoma. 

It probably contains a number of principles, the chief of which 
are, however, jervine and veratroidine. 

Veratrum viride is the safest and best circulatory depressant that 
we have for use in adults. 

Physiological Action. — The physiological action of this drug is to 
be considered under the effects of its two alkaloids before the com- 



plete effect is studied. 



Jervine. 



When jervine is given in full toxic dose it causes great slowness 
of movement, relaxation of the muscles, through which thrills con- 
tinually run, and finally the animal falls to the ground. Violent epi- 
leptiform convulsions may now ensue, but no tetanus is present. The 
convulsions soon give place to paralysis, and are characterized by 
their lack of force. Sensation is not affected until the near approach 
of death brings on anaesthesia. There is no evidence of gastro- 
enteritis and no vomiting or purging. The saliva is always increased 
and pours from the mouth. Death results by failure of the respira- 
tory centres and an almost simultaneous failure of the heart. The 
heart and circulation are greatly depressed, and the pulse-rate and 
force are far below their normal rate and strength. 

The blood-pressure is very low, except when the convulsion pro- 
duces a temporary rise, but the condition of the vagi is apparently 
normal. Jervine acts as a direct depressant to the vasomotor centres. 
The convulsions are due to the disturbance of the circulation at the 
base of the brain (Wood), and the spinal cord is directly depressed by 
the action of the jervine on its motor tracts. 



VEBATRUM VIRIDE. 355 



Veratroidine. 

This alkaloid is much more irritating than jervine, and in over- 
dose causes vomiting and purging. The muscular twitchings and 
convulsions caused by jervine are also produced by veratroidine, but 
are generally not so severe. It also depresses the spinal cord in its 
motor tracts. 

On the circulation veratroidine slows the pulse by stimulating the 
pneumogastric centres, but finally quickens it if given in very large 
doses, by paralyzing the peripheral vagi. 

The following summary, given by Wood, of the circulatory effect of 
veratrum viride, from a study of its alkaloids, is so brief and terse as 
to be worthy of insertion here : u Veratrum viride slows the pulse by 
a direct depressant action on the heart-muscle (jervine) and by stim- 
ulating the pneumogastric nerves (veratroidine); it lowers blood-pres- 
sure by an action on the heart-muscle (jervine) and by depression of 
the vasomotor centre (jervine)." 

Poisoning. — Veratrum viride, while one of the most powerful drugs 
we have, is one of the least dangerous, since it almost invariably causes 
vomiting before enough of the drug is absorbed to produce serious 
consequences. The vomiting is partly due to the veratroidine and 
partly to the presence of an irritant resin. In poisoning, cardiac 
stimulants, atropine, external heat, the placing of the head below the 
feet on an inclined plane, and the use of strychnine as a respiratory 
and nervous stimulant are to be resorted to. 

Therapeutics. — The chief use of veratrum viride is as a circula- 
tory sedative in acute, sthenic, or dynamic inflammations. In pneu- 
monia, pleurisy, acute hepatitis, peritonitis, and cerebritis it is of the 
greatest value if given at the proper stage, when only congestion 
or hyperemia is present. After the onset of the lesions follow- 
ing this period its use is not only valueless, but malpractice. The 
only objection to the employment of veratrum viride in peritonitis 
lies in its tendency to produce vomiting, which is, of course, harmful 
when the peritoneum is inflamed. For this reason aconite is preferred 
to veratrum viride in peritonitis. Owing to its physiological influence 
veratrum viride bleeds a man into his own blood-vessels, and the indi- 
cations for its use are the same in inflammation as they would be for 
bleeding. In puerperal fever it has been highly recommended, but 
must be most carefully employed. With a large number of practi- 
tioners veratrum viride is considered by far the best remedy in puer- 
peral eclampsia. If given in this condition the dose must be large, 
as much as 20 to 30 drops (1.3-2.0) of the tincture. If swallow- 
ing is difficult, it may be used hypodermically in half the dose, pro- 
vided the circulation is carefully watched to avoid too great depres- 
sion. It acts in eclampsia chiefly by its depressant effect on the 
motor tracts of the spinal cord. It is also of value in excessive car- 
diac hypertrophy and in the irritable heart of strong, healthy men. In 
aneurism where the circulatory disturbance is great and the arterial 



356 DRUGS. 

pressure high the drug may be used, with great care, to decrease the 
pressure and prevent rupture of the diseased vessel. 

Contraindications. — Veratrum viride is contraindicated in all 
conditions of depression or exhaustion, and, if vomiting is feared, 
must not be given in peritonitis or gastritis, as it may cause emesis 
and in this way disturb and irritate the abdominal contents. 

Administration. — The drug in inflammation should be given every 
half-hour or hour, and at least 1 drop (0.05) of the tincture should be 
used each time in a healthy adult. In the course of two or three 
hours or less the skin becomes moist or relaxed, the pulse slower and 
less angry, and slight nausea may be present. These symptoms show 
that the drug is exerting its influence, and it should now be withdrawn 
or in very sthenic cases pushed a little farther. If vomiting comes 
on before the drug has acted on the circulation, 5 to 10 drops (0.35— 
0.65) of laudanum should be given fifteen minutes before each dose 
of veratrum viride. The best preparations to employ is the tincture 
{Tinctura Veratri Viridis, U. S. and B. P.), dose 1 to 3 drops (0.05- 
0.15). The fluid extract (Extractum Veratri Viridis Fluidum, U. S.) 
is given in the dose of 1 to 3 drops (0.05-0.15). Under the name 
of Norwood's Tincture a saturated tincture has been sold. It is not 
official, and ought never to be used. 



VIENNA PASTE. 

Potassa cum Calce, U. #., is a milder and more manageable eschar- 
otic than is caustic potash, and is used for the same purposes. (See 
Caustic Potash.) 

WARBURG'S TINCTURE. 

Warburg's Tincture is a complex liquid formed by the mixing 
together of no less than thirteen ingredients. Its inventor, Dr. War- 
burg, held its composition as a secret for a time, but finally made it 
public. Since he published the original formula it has been consid- 
erably altered, and some of the preparations now sold as Warburg's 
tincture contain none of the original ingredients. Further than this, 
some of these ingredients are now not obtainable. It ought to be 
made as follows, if possible : 

Aqueous extract of aloes 28 grains. 

Khubarb 448 « 

Angelica-seed 448 

Elecampane 224 

Saffron 224 " 

Fennel 224 " 

Gentian 112 

Zedoary-root • • • H2 

Cubeb 112 " 

Myrrh 112 " 

White agaric 112 " 

Camphor 112 " 

Sulphate of quinine • 1280 

Dilute alcohol enough to make 8 pints. 



ZINC. 357 

The coarse vegetable portions of this list are to be ground into a 
coarse powder, and the myrrh and camphor, which have been pre- 
viously pulverized, added to them. The entire mass, less the quinine, 
is then digested for twelve hours in a well-covered vessel on a water- 
bath, the alcohol being prevented from evaporating as much as pos- 
sible. The liquid is now to be strained under pressure and the sul- 
phate of quinine added and dissolved. 

Therapeutics. — Warburg's tincture, next to pilocarpine, is the most 
powerful sweat-producer that we have, and possesses in addition very 
remarkable antimalarial power. In this last respect it far exceeds 
quinine as a remedy in pernicious malarial regions for acute attacks 
and as a prophylactic. Its advantages over quinine rest in its favor- 
able action where congestions accompany the paroxysm. 

Administration. — To be of any value Warburg's tincture should 
be given according to the following rules : The bowels of the patient 
should be first opened thoroughly by a saline purge, and J an ounce 
(16.0) of the tincture should be given in one dose undiluted, no drink 
being taken. After the lapse of two or three hours a second J ounce 
(16.0) is given in the same way, and very shortly a profuse sweat 
appears, which often marks the crisis of the disease, and recovery 
soon takes place. 

ZINC. 

Zincum is not employed in medicine in its metallic form, but in 
the form of several of its salts. 

Physiological Action. — Nearly all the salts of zinc are somewhat 
astringent, and when taken internally act as depressants to the ner- 
vous system. Some of them are more irritating than others, such as 
the chloride and sulphate, whereas the valerianate has almost no 
power except so far as the valerianic acid is concerned. 

All of the salts when taken for a long time in excess produce 
organic changes in the nervous system, generally represented by a 
myelitis, which differs from that caused by lead, which is ascending, 
while that of zinc is transverse. 

Zinc is eliminated by the liver and kidneys. Chronic poisoning 
among workers in zinc is rare, but has occurred. The symptoms 
closely resemble those of chronic lead poisoning. 

ZINC ACETATE. 

Zinci Acetas, U. S. and B. P., occurs in the form of white mica- 
ceous crystals, which are efflorescent and quite soluble in water. It 
acts as a decided astringent to the skin and mucous membranes, but 
is less astringent than the sulphate of zinc. It is used as a collyrium 
in eye diseases, such as conjunctivitis, in the strength of 1 to 2 grains 
(0.05-0.1) to the ounce (30.0). In gonorrhoea it is often employed 
instead of the acetate of lead in injections of the strength of 1 to 20 
grains (0.05-1.3) to the ounce (32.0) of rose-water. 

The treatment of poisoning by acetate of zinc is that adapted to 
gastro-enteritis. (See Gastro-enteritis, Part IV.) 



PART III. 

REMEDIAL MEASURES OTHER THAN DRUGS- 
FOODS FOR THE SICK. 



ACUPUNCTURE. 

This is a term applied to the insertion of a small pointed instru- 
ment into the tissues of any part of the body for the purpose of 
relieving pain, swelling, or dropsies. When used in painful affections 
it accomplishes its best results in lumbago and sciatica, particularly 
in the former. When treating lumbago in this manner the writer 
takes two darning-needles, places them in boiling water to render 
them aseptic, inserts them one to one and a half inches, and allows 
them to remain in place for several minutes. They are then slowly 
withdrawn, care being taken to prevent them from breaking off. Often 
after this treatment the patient can at once move more freely, to his 
great delight. Ringer has, with his usual clear clinical insight, noted 
that this treatment is more successful in those who have bilateral pain 
than in those who have one side affected, and the writer has found 
this statement invariably true. 

In sciatica acupuncture is less successful than it is in lumbago, but 
is always to be tried. The needle should be carried down until it 
reaches the nerve, and perhaps pierces its sheath, and it must be 
absolutely aseptic. Bartholow has recommended the use of a hypo- 
dermic needle for the simultaneous injection of a few minims of chlo- 
roform or morphine. Sometimes the best results are reached from 
inserting the needle immediately below where the nerve finds exit 
from the pelvis. In other cases it is asserted that the insertion of a 
needle on the sound side over a spot corresponding to that which is 
sore mav do good. Acupuncture is useless in acute rheumatism and 
for the lumbar pain produced by fevers. 

Sometimes a rhigolene spray may be used to freeze the skin over 
the parts with advantage in lumbago or sciatica. 

Acupuncture is occasionally resorted to for the relief of dropsy, 
but it is not commonly employed, although it is often a useful meas- 
ure. When the skin of the limbs becomes so tense with an effusion 
as to endanger its life, the tension should be relieved by incisions, 
not punctures ; but saline purges are better for the removal of dropsy, 
if they can be used. Punctures rapidly close and make hard spots, 

359 



360 REMEDIAL MEASURES OTHER THAN DRUGS. 

while incisions remain open and permit free drainage. Immediately 
after the incisions are made the parts are to be dressed with cotton 
previously saturated with boric-acid solution and dried, or by absorb- 
ent cotton sterilized by baking it in an oven. It is hardly necessary 
to point out that the incision must be made under antiseptic precau- 
tions. (See Antiseptics.) 



ANTISEPTICS. 

The term "antiseptic," as generally used, does not necessarily 
imply the power to destroy pathogenic germs. Any substance which 
inhibits the growth of micro-organisms, which destroys or renders 
innocuous the poisonous products of their action upon the tissues of 
the body, or which retards or prevents the absorption of such products 
is properly termed antiseptic. Since germicides necessarily possess 
antiseptic attributes, they should, strictly speaking, be classed with 
antiseptics ; in this portion of the work, however, only such drugs as 
are sufficiently innocuous to allow of their use in the human body or 
upon its surface will be considered. Some of these — as, for instance, 
carbolic acid and bichloride of mercury — are efficacious solely from 
their germicidal properties. Others, and of this class iodoform is the 
most important and typical example, exert their influence, not upon 
the micro-organisms, but upon the toxic substances formed by these 
organisms. 

Of the long list of antiseptics which have within recent years 
received warm commendation at the hands of individual writers, 
there are comparatively few which have retained the confidence of 
the profession after prolonged trial. Only these few well-proven 
drugs will be discussed in this article. 

Heading the list, and in its germicidal power far surpassing all 
others, is Bichloride of Mercury. Long since the researches of Koch 
have shown that this salt is efficacious as a germicide in a watery 
solution of 1 : 50,000. He stated, however, that where albumin was 
present the bichloride was decomposed and rendered inert. The same 
change was observed when solutions were allowed to stand for some 
length of time, even when distilled water was used as a solvent. By 
the addition of either sodium chloride or a weak acid such decomposi- 
tion was prevented. 

From this it follows that under ordinary circumstances solutions 
of bichloride should be freshly prepared, or, if it is desirable to keep 
them for a long time, a sufficient amount of sodium chloride should 
be added to prevent precipitation of the mercury salt. Koch advised 
that as much salt should be added as w T ould equal the weight of the 
sublimate. Other observers, however, have advised ten times this 
weight of sodium chloride. 

Since whenever bichloride solutions are used in wounds or in cavities 
of the body they are brought in contact with blood-serum or other 
albumin-bearing substances, care must be taken that the antiseptic 
powers of the mercury lotion are not destroyed by the decomposition 



ANTISEPTICS. 361 

of its active principle. The power of the solution may be preserved 
by using it in such large excess that the small amount of chemical 
change has practically no effect, or by combining with it, as stated 
above, an acid which will not in itself be unduly irritating to raw 
surfaces. This end is accomplished by tartaric acid. In making up 
a solution 1 part of bichloride and 5 parts of tartaric acid are added 
to as much water as is needed. Thus, in making up a solution of 
1 : 1000 for surgical purposes, the following prescription may be 
employed : 

R. — Hydrarg. chlorid. corros. . . . - gr. xv (1.0). 

Acid, tartaric gr. xv vel 3J (4.0). 

Aquse dest Oij (1 litre). — M. 

Bichloride solutions are used in the strengths of 1 : 500, 1 : 1000, 
1 : 2000, and 1 : 4000 in the treatment of ordinary wounds. For 
the irrigation of large cavities solutions of a strength greater than 
1 : 10,000 should rarely be employed, and even these dilute lotions 
have, when used in the peritoneal cavity, given rise to toxic sj^mp- 
toms. The 1 : 2000 solution is the one generally employed for steril- 
izing wounds and irrigating during operations. The stronger solu- 
tions of 1 : 500 or 1 : 1000 are used in cleansing the surface of the 
body. 

The ordinary method of preparing a surface of the body for opera- 
tion is as follows : The part is first thoroughly scrubbed with green soap 
and warm water, is shaved, and is washed again as before. It is then 
cleansed with alcohol or ether, after which a scrubbing with bichloride 
solution of 1 : 500 should follow, and should be continued for at least 
two minutes. If no surgical interference is immediately indicated, the 
whole operative region should be enveloped in towels wrung out in a 
solution of 1 : 1000 or 1 : 2000, and kept thus protected until the sur- 
geon is prepared to operate. The moment the skin is incised no lotion 
stronger than 1 : 2000 should be employed, or if the more powerful 
solutions are used they should immediately be flushed out with one 
of less strength. The dressings, unless some particular form is used, 
may consist of boiled, bleached, and sun-dried gauze, soaked in a 
1 : 500 bichloride solution and subsequently washed and wrung out 
in a 1 : 4000 dilution of the same antiseptic. 

Next in order of importance and in efficacy among the antiseptic 
preparations is Carbolic Acid and its solutions. The particular value 
of this drug lies in the fact that its potency is equally developed in 
both albuminous and non-albuminous solutions. Like the mercury 
salts, its great disadvantage lies in its toxic properties. It is usually 
used in solutions of 1 : 20 and 1 : 40. The carbolic acid of commerce 
is found in a liquid form, dissolved in alcohol, and represents a strength 
of about 95 per cent. In making the solution for surgical purposes 
an ounce of this liquid is added to 20 or 40 ounces of water, accord- 
ing to the strength of the solution desired. Although carbolic acid 
is soluble in 15 parts of water, this solution does not take place imme- 
diately, and in making solutions of a strength of 1 : 20 either the 
water must be hot or a certain amount of time and considerable agi- 



362 REMEDIAL MEASURES OTHER THAN DRUGS. 

tation of the mixture are required, otherwise globules of almost pure 
carbolic acid are deposited in the bottom of the tray or vessel into 
which the solution is poured, and these, by coming in contact with 
instruments or with the hands of the operator, exert an undesirable 
cauterant effect. 

The 1 : 20 solution is used for the disinfection of instruments and 
the cleansing of surfaces. For half an hour before an operation it is 
customary to submerge all instruments which will be required in a 
solution of this strength, and when the surgeon is ready to use these 
instruments the solution is diluted to 1 : 40 by the addition of an equal 
volume of Avater which has been boiled. If a carbolic lotion is em- 
ployed for irrigation or for cleansing sponges during an operation, it 
should not be stronger than 1 : 40. 

A property possessed by carbolic acid, which renders it an unsafe 
medium for the impregnation of gauze, is its volatility. After an 
exposure of a few hours to the atmosphere it entirely evaporates, 
leaving not an antiseptic, but simply a sterile, dressing. This fact is 
utilized by the surgeon in the preparation of the deeper layers of the 
dressing, which come in immediate contact with the lips of the wound. 
Since all antiseptics are more or less irritating to raw surfaces, heal- 
ing will be promoted by a sterile rather than by an antiseptic appli- 
cation. By moistening a piece of boiled and sun-dried gauze, suf- 
ficiently large to cover the wound-edges, in a carbolic solution of 1 : 
20 the antisepticity of this dressing is assured, and in a very few 
hours the heat of the body causes the entire evaporation of all the 
carbolic acid, leaving a sterile, non-irritating surface in contact with 
the wound, If protective is used or oiled silk is applied beneath the 
dressing, these materials should be treated with carbolic acid in the 
same way. 

In addition to its toxic effect upon the patient, carbolic acid greatly 
irritates the hands of the surgeon, and if used in a strength of more 
than 1 : 40 causes so much benumbing of tactile sensibility that 
manipulative skill is seriously interfered with. The cracked and fis- 
sured fingers resulting from the use of carbolic lotions are familiar to 
all, and at times produce results of far more serious import than tem- 
porary pain and discomfort: many recesses are provided in the depths 
of which septic germs may successfully resist the action of antiseptic 
washes. There can be no question that septic poisoning has been 
frequently due to this fact. 

Bichloride-carbolic Acid Solution. — Since bichloride, though the 
most powerful antiseptic, has but little penetrating power and is 
rendered inert by albumin, and since carbolic, though of more feeble 
antiseptic strength, possesses the very qualities of penetration and 
non-neutralization which bichloride lacks, it would seem natural that 
the best results might be obtained by a judicious mixing of these two 
antiseptics. In recent times this procedure has been adopted in many 
clinics and with most satisfactory results. 

For cleansing the hands and purifying operation areas, in place of 
a simple bichloride mixture a solution which represents bichloride 



ANTISEPTICS. 363 

1 : 500 and carbolic acid 1 : 40 is employed. Immediately before ope- 
ration all sponges are wrung out from this solution. 

For flushing wounds, for cleansing sponges during the course of 
operation, and for the final soaking of the antiseptic dressing imme- 
diately before its application, a solution of bichloride of mercury 
1 : 4000 and carbolic acid 1 : 100 is employed. 

The method of preparing these solutions is of course exceedingly 
simple. If crude drugs are used, these are put into a given measure 
of water in sufficient quantity to represent the strength desired, but 
when, as is frequently the case, these solutions are made up in stand- 
ard solutions, some thought is required to avoid mistake. Thus, 
given a standard solution of 1 : 2000 bichloride and one of 1 : 50 
carbolic, mixture of these two would make the lotion customarily 
employed in clinical practice — L e. bichloride 1 : 4000 and carbolic 
1 : 100. The calculation involved in making this solution from 
standard lotions of carbolic 1 : 20 and bichloride 1 : 1000 is somewhat 
intricate, and liable to result in error ; hence it is best either to pre- 
pare the entire solution freshly each time or to keep on hand prepa- 
rations of such strength that the calculation is easily and quickly 
made. 

Iodoform occupies a unique place among antiseptics in having been 
almost universally accepted and used by surgeons and clinicians, in 
spite of the fact that its germicidal action has been well proved by 
laboratory research to be practically nil. It is found that nearly all 
forms of pathogenic germs grow abundantly upon culture materials 
the greater part of which is made up of iodoform, and that injections 
of such germs, mingled with large quantities of iodoform, produce 
the characteristic effect upon living tissues with almost as great cer- 
tainty as though this drug had not been used ; furthermore, it has 
been shown that iodoform is not even sterile, and that as employed 
by surgeons it was frequently a cause of infecting previously aseptic 
wounds. 

In spite of this overwhelming evidence against it the drug steadily 
grows in favor. Recent researches have explained, in part at least, 
the reason for this contradiction between experimental and practical 
results. It has been well said that the human body is not a test-tube, 
and that bacteriological research cannot supplant the evidence of 
clinical observation. Elaborate investigation showed that this drug 
acted as a powerful antiseptic, not by destroying the germs, but by 
undergoing a decomposition in their presence, the products of which 
render the ptomaines, the result of germ-growth, inert. In this way 
suppuration is, to a certain extent, inhibited, or if present its disas- 
trous effects upon the system at large are prevented, since these are 
due to ptomaine absorption rather than to a direct effect of the micro- 
organisms themselves. It has been apparently proved that ptomaines, 
in themselves and without the presence of micro-organisms, can gen- 
erate pus, but that where such ptomaines are mixed with iodoform 
before infection no pus is formed. If these septic chemical compounds 
are rendered inert, a powerful adjuvant to the destructive action of 
the germ upon living cells is removed, and thus the system is often 



364 REMEDIAL MEASURES OTHER THAN DRUGS. 

enabled to overcome one enemy where two would have prevailed. The 
fact that iodoform is in itself not sterile is, from a practical stand- 
point, most important. Fortunately, sterilization is readily accom- 
plished. A thorough washing in a 1 : 1000 bichloride solution destroys 
all micro-organisms, and the powder, after being washed with freshly- 
distilled water, may then be used without fear of producing infection. 

It will be readily understood from the foregoing that iodoform is 
of little service in aseptic wounds ; that it becomes of utility in direct 
proportion to the foulness of discharge ; and that to exert its influence 
it must be applied directly to the part. It is liable, in suppurating 
wounds, to form a hard crust with the discharges, thus frustrating 
one of the most important indications in antiseptic surgery — i. e. 
drainage. Particular care should be exerted to see that the exuda- 
tion from the surfaces of the wound has a free exit. 

As employed in surgery, iodoform, after having been sterilized, is 
placed in small pill-boxes or wide-mouthed jars, over the opening of 
which is tied a single layer of antiseptic gauze ; through this the iodo- 
form is sprinkled as desired over wound surfaces. 

Kreolin, or Creolin, a preparation obtained from English coal by 
dry distillation, has been steadily and rapidly growing in popular 
favor, and because of its feeble toxic action is often preferred to car- 
bolic acid. In addition to its powerful germicidal effect, it is non- 
irritant and practically non-toxic. The claim first advanced that this 
preparation was absolutely non-poisonous can no longer be supported, 
since cases have been reported where toxic symptoms have followed 
its use : these were probably due to individual idiosyncrasy, a factor 
which we can never hope entirely to overcome. It is certainly true 
that kreolin is the least poisonous of all the powerful antiseptics 
heretofore used. As an additional advantage, in place of the harsh, 
irritating effect produced upon surfaces by carbolic-acid solutions, 
kreolin exerts an influence very like that of an oily or mucilaginous 
preparation. 

The extravagant claims advanced for kreolin in regard to its 
germicidal property have not been confirmed by bacteriological inves- 
tigation. In solutions containing albumin it is not efficient as a germ- 
icide in strengths of less than 1 : 100, its power being somewhat 
below that of carbolic acid; since, however, its toxic properties are 
much less marked than those of the latter drug, it can be safely used 
in stronger mixtures, and therefore, for practical purposes, its strength 
is greater. 

Kreolin, though insoluble in water, readily forms an emulsion quite 
as efficacious in its antiseptic properties as a true solution. Since this 
emulsion is opaque, it is scarcely applicable for immersing and steril- 
izing instruments, the latter not being readily found. It is admirably 
suited, however, for cleansing the hands, a 5 per cent, solution neither 
cracking the skin nor benumbing the sensory nerves. In irrigating 
large wounds, cavities of the body, and particularly as a means of 
preventing sepsis or aborting it in gynsecological work, kreolin can be 
warmly commended. It may be employed in a strength of from 0.2 
to 5 per cent. 



ANTISEPTICS. 365 

Barring the opacity of its emulsion in water, it would be the 
medium par excellence for rendering instruments sterile and main- 
taining them in this condition during an operation. 

Among the many antiseptic agents of less importance may be men- 
tioned Peroxide of Hydrogen. This drug comes in what is termed a 
fifteen-volume solution. By this it is meant that fifteen volumes of 
feebly combined oxygen are contained in each volume of the liquid. 
It is applicable, not to sterile surfaces, but to suppurating wounds 
and sinuses. It is alleged that peroxide of hydrogen immediately 
destroys the micro-organisms of pus, converting, in one or two applica- 
tions, a septic wound into one which is sterile and which will promptly 
heal. It is used in the strength of from 5 per cent, up to full con- 
centration. Its disadvantages lie in the fact that it is expensive, 
that from higher acidity it is often irritating, and that it readily 
undergoes decomposition. In this latter circumstance, possibly, lies 
the explanation of its want of popularity, since the preparations vary 
so greatly in strength that it is impossible to determine to what 
extent they should be diluted or what may be their potency when 
applied. When this drug is poured into a suppurating sinus or cavity 
an ebullition takes place, which ceases only when the drug is exhausted 
or the infected surfaces are rendered sterile. 

Chloride of Zinc has been extensively employed in some clinics as 
an antiseptic application. It is used in 10 per cent, solutions, and is 
applied when the field of operation is probably infected by pre-exist- 
ing pus-formation. Although bacteriological research has shown that 
this agent possesses feeble antiseptic power, clinical experience dem- 
onstrates its great value when applied to infected surfaces. Lately 
the Sulpho-carbolate of Zinc has to a great extent replaced the chlo- 
ride, as it is less toxic and irritating and far more potent. 

For the sterilization of mucous surfaces a saturated aqueous solu- 
tion of Boric Acid is commonly employed. 

Double Cyanide of Mercury and Zinc. 

This is the latest antiseptic prepared and extensively used by 
Lister. Though it has not become widely popular, Lister's commen- 
dation of it is so warm that a general description of its use is in 
place. 

The drug comes to the surgeon in the form of a fine powder. 
When employed for charging a dressing it is diffused by means of 
pestle and mortar in solution of bichloride of mercury (1 : 4000) in 
sufficient abundance to drench the fabric thoroughly, for which 4 
imperial pints to 100 grains of the salt will be found adequate. This 
will give a percentage of between 2 and 3 of the cyanide to the dry 
gauze. The gauze should always be used moist, and if it be prepared 
for immediate use, as by the dispenser of a hospital, the process of 
drying may be omitted, and the gauze, after being hung up for a 
while to drain, is further deprived of superfluous moisture by placing 
it for a while in a folded sheet. It may afterward be conveniently 
kept moist by wrapping it in a piece of mackintosh cloth. When 



366 REMEDIAL MEASURES OTHER THAN DRUGS. 

obtained dry from the manufacturer it should be moistened again with 
a weak corrosive-sublimate solution before it is used." 

The advantages claimed for this dressing are that it is not irritat- 
ing to the skin, and that the antiseptic substance is not soluble, hence 
is not washed out by discharges. 

An omission of the details of cleansing the hands of the surgeon 
and assistants in preparing for an antiseptic operation is scarcely 
permissible in writing upon the subject of antisepsis. The most 
approved method is as follows : 

The hands and forearms are thoroughly brushed in hot soap-suds 
for several minutes, after which the nails are carefully cleaned by a 
knife and brush, and the washing again repeated ; the hands are then 
washed in alcohol for one minute, special attention being paid to the 
nails; finally they are soaked for three minutes in a solution of 
bichloride (1 : 1000), and during the course of the operation are 
occasionally washed in a solution of the same strength. If it is neces- 
sary to lift a chair, to turn the patient, or to touch any object which 
has not been previously sterilized, the hands should be enveloped in 
towels wrung out in 1 : 1000 solution or immediately washed again. 
Another method which has been found by Kelly to be the best, bac- 
teriologically and practically, is to cleanse the hands and nails by 
scrubbing with hot water and soap, and then to immerse the hands 
and arms in a saturated solution of permanganate of potassium made 
with hot water. After this the skin is decolorized by immersion in a 
saturated solution of oxalic acid. Finally, the oxalic acid is washed 
off with hot sterilized water. 



CLIMATIC TREATMENT. 
(See Springs and Climates.) 

COLD AS A REMEDY. 

Cold, or the rapid abstraction of heat, is a remedial measure that 
can nearly always be obtained, and is possessed of very great power 
for good in properly selected cases. At the very first we may divide 
its use into its local application, for a superficial limited, deep-seated, 
or distant influence, and its general application for the purpose of 
affecting the entire body. 

When cold is applied for its limited and local action it is always 
used with two objects in view — namely, to cause localized contraction 
of blood-vessels which through inflammation are engorged, so that the 
parts are reddened and swollen, or temporarily to anaesthetize or 
benumb a nerve-fibre for the immediate relief of pain, and with the 
hope that the temporary paralysis may ultimately result in such nerve- 
changes as to produce a cure, 

For these reasons cold, in some form, is a popular remedy for a 



COLD AS A REMEDY. 367 

burn or sprain or any injury likely to be followed by inflammatory 
processes. In some cases, it is true, hot water or dry heat is equally 
efficacious, and this fact will be referred to again when speaking of 
heat. (See Heat.) It may, however, be stated, as an almost invaria- 
ble rule, that the choice of heat or cold is to be governed by the sen- 
sations of the patient, who will generally assert that one of the two 
is the more agreeable. 

Cold or heat causes relief of pain in inflammation by producing 
contraction of the local blood-vessel walls. As a result, inflammatory 
exudates do not occur, congestion is relieved, and as the pressure on 
the nerve-filaments ceases the pulsating pain of inflammation passes 
away. 

A very useful remedy for the sprain of an ankle when it is a recent 
accident is to let the patient sit with the foot elevated, with a cloth 
wrung out in ice-water or an ice-bag applied over the part affected. 

In the treatment of localized pain cold is used in a number of 
ways, largely depending in their choice on the will of the physician 
and the wealth of the patient. The simplest, cheapest, and perhaps 
the most efficient method of using cold is to place cracked ice in a 
pig's or sheep's bladder, and, after tying the opening to prevent leak- 
age, to lay the bladder directly on the skin, surrounding it with a 
towel, so as to prevent the moisture, which appears on the surface 
from condensation, from wetting the clothing. 

Where a very limited and comparatively transient effect is needed, 
it is customary in hospital and private practice to use a piece of ice 
sprinkled with a little fine salt, and held against the skin by means 
of a towel in the hands of a physician. Actual freezing can often be 
produced in this manner very rapidly. 

Where a more rapid and elegant method is desired, sprays of 
various very volatile liquids may be driven against the part by an 
atomizer. Probably the most readily employed of these liquids is 
ether, which is fairly effective if it is used in a fine spray and driven 
against the skin in such a way as to favor rapid evaporation. Another 
of these agents is rhigolene, which is one of the lightest and most 
volatile of the liquid products of coal-tar, and is used in a spray from 
an atomizer in the same manner as is ether. Chloride of methyl is a 
. liquid of a sweetish smell and taste, used as a substitute for rhigolene 
as a local anaesthetic through the intense cold produced by its appli- 
cation. The fluid is directed against the skin over the involved area 
by means of a nozzle attached to the cylinder containing it. (See 
Chloride of Ethyl and Methyl.) 

It is hardly necessary for the writer to repeat that, as the last 
three applications are very inflammable, they should not be used near 
a light or fire. 

Aside from the local effects of cold on inflammatory processes, it is 
largely resorted to for the relief of neuralgia of a superficial type, 
and has often been used for the cure of deep-seated neuralgias, as over 
the course of the sciatic nerve in sciatica. Generally, however, it is 
employed in neuralgia of the supraorbital nerve, where, owing to the 
superficial position of these fibres, the cold can readily penetrate. 



368 REMEDIAL MEASURES OTHER THAN DRUGS. 

The skin should be distinctly whitened and blanched, and even hard- 
ened, by the cold before its application is stopped, and if one applica- 
tion does not cause a cure, it may be repeated every day for several 
weeks in obstinate cases. Sometimes cold is used to benumb the skin 
or subcutaneous tissues in cases where a minor surgical operation is to 
be performed, and it is undoubtedly superior to cocaine Avhere one 
wishes to open boils or small abscesses. It is also valuable when the 
physician is using the actual cautery, and in all these cases may be 
employed as is indicated above. 

The local employment of cold for the influencing of deeply-seated 
organs is a well-recognized therapeutic measure of great practical and 
physiological interest, and is closely associated with the subject of 
counter-irritation. (See Counter-irritation.) According to Winter- 
nitz, cold applied to the feet affects the cerebral circulation, cold to 
the thighs the circulation in the lungs, and cold to the back the cir- 
culation around about the pituitary region. That these assertions are 
true we do not positively know, but the fact that Winternitz has 
reached them by a series of experimental studies indicates their cor- 
rectness to a great extent, and they also find additional support in 
the popular and medical confidence in the use of cold to the head and 
heat to the feet in cerebral diseases. 

Practically, cold has been employed with no small degree of suc- 
cess in the treatment of pneumonia and pleurisy in the form of the 
ice-poultice or ice-jacket. The only thing needful for such treatment 
is a condition of strength on the part of the patient, for it should not 
be used in adynamic cases. When the ice-poultice is used it is made 
by taking a mass of finely-chopped ice, draining it of all water, and 
mixing it thoroughly with dry sawdust in sufficient quantity to 
absorb all the water derived from the ice as it melts. This is then 
basted into a quilt, so arranged that all of the contents will not sag 
to the lower border, and wrapped around the chest, the mass being 
thoroughly covered by a layer of well-oiled silk. Cold has also been 
highly recommended when used in pneumonia in another manner, and 
by no less prominent an authority than Niemeyer, who speaks of it 
as follows : 

" I have made extensive employment of cold in the treatment of 
pneumonia, and, relying upon a large number of very favorable 
results, can recommend this procedure. In all cases I cover the chest 
of the patient, and the affected side in particular, with cloths which 
have been dipped in cold water and wrung out. The compresses 
must be reapplied every five minutes. Unpleasant as this procedure 
is in almost all cases, yet even after a few hours the patients assure 
me that they feel a material relief. The pain, the dyspnoea, and often 
the frequency of the pulse are reduced. Sometimes the temperature 
goes down an entire degree. My patients often retain this surpris- 
ing condition of improvement throughout the entire duration of the 
attack, so that their outward symptoms would hardly lead one to 
imagine the grave internal disorder. The relatives of the patient, 
too, who do not fail to perceive the improvement, now readily assist 
in the treatment to which at first they were opposed. In a few cases, 



COLD AS A REMEDY. 369 

and only in a few, the use of cold affords no relief, and the trouble- 
some manipulation for its application increases the distress of the suf- 
ferers so much that they refuse to keep it up. In such cases I have 
not insisted upon the further application of cold. 

"In the hospital at Prague every case of pneumonia is treated 
with cold compresses, and, according to the statements of Smoler, it 
is exceptional for a patient not to feel material relief from this treat- 
ment. I should only ascribe a palliative influence to their use had 
not the duration of the disease in many instances been decidedly 
shortened and the convalescence hastened by means of their energetic 
and methodical employment. In fact, in but few cases have we seen 
the disease delay its departure until the seventh day. Many have 
improved on the fifth, and a very large number as early as the third 
day ; nay, I have repeatedly found it impossible to keep patients 
with recent pneumonia in the hospital for a longer period than a 
week. Cold is rightly regarded as one of the most efficient antiphlo- 
gistics in inflammation of external organs. Its action is directly tonic 
upon the relaxed tissues and dilated capillaries." 

In endocarditis, and especially in pericarditis, do we find an ice- 
bag placed over the heart a valuable remedial procedure, for it relieves 
palpitation and quiets the heart, decreases the pain and diminishes 
the inflammation. 

The use of a cold bath for the purpose of increasing the tone of 
the system is as old a custom as any which we have, but, like all 
other things in medicine, cannot be used without distinct indications 
for its employment, or, to speak more correctly, the absence of cer- 
tain contraindications. The most universal exception to its use which 
we find is that class of persons with whom bathing of any kind, par- 
ticularly when it is frequently repeated, does not agree. The writer 
is sure that a much larger number of persons belong to this class 
than is generally recognized, and he has seen cases of nervous exhaus- 
tion and general loss of vivacity and vitality occur as a result of too 
frequent bathing. This is the case more especially with daily bathers 
who use cold or warm fresh water, particularly if the bath be taken 
in the morning. 

Before passing on to a consideration of the physiological action 
of a bath, and why and when we should use it, it is proper to call 
attention to the fact that a very large proportion of children who are 
bathed daily are allowed to lie and soak in the tub, and as a result 
become debilitated and fretful, only to recover when the bath is used 
once or twice a week, and replaced in the interval by a nightly spong- 
ing off with salt and whiskey or salt and water. 

Through practical experience and much experimental research of 
a more or less reliable character, we now know that the following 
phenomena accompany the use of a cold bath in a healthy person with 
whom such a bath agrees : 

On entering the water he shivers, thinks it almost unbearably 
cold, his teeth chatter, and he gasps if the cold suddenly touches the 
belly-wall or an equally sensitive surface. In a moment, however, 
reaction sets in, and the extremities, heretofore blue, trembling, and 

24 



370 REMEDIAL MEASURES OTHER THAN DRUGS. 

covered with cutis anserina, become warmer and flushed. The pulse 
is increased in force and frequency, and the respirations are deeper 
and more thoroughly performed. As a result of this each portion of 
the body receives a more perfect supply of blood and feels rejuve- 
nated. Following this stage of exhilaration, a third comes on, in 
which the blueness and depression of the first stage recur in an exag- 
gerated degree, but this condition does not ensue unless the person 
remains too long in the water. If he leaves the bath while in the 
acme of his exhilaration, the stimulus may remain with him through- 
out the rest of the day. 

The reason for the occurrence of this train of symptoms is not far 
to seek. The chilliness of the first stage shows that the great abstrac- 
tion of heat is lowering the bodily temperature, the centres for calori- 
fication in the body not manufacturing all the heat that is needed for 
the preservation of the normal temperature. At first the cold drives 
the blood hurrying into the warm recesses of the body, leaving the 
surface of the body cold ; but in a few moments the system is aroused 
to the recognition of the fact that it must increase its exertions in 
the propulsion of blood and manufacture of heat, and so, with an 
effort it puts forth all its power, picks up each corpuscle that is hiding 
from the cold in the internal organs, and, after imbuing it with warmth 
obtained by increased heat-production in the sources of heat-manu- 
facture, forces it out to the surface of the body along with its fel- 
lows, which are driven to all parts of the system. This is not a 
mere figurative way of putting the matter, for cold always contracts 
blood-vessels and reflexly stimulates the vital centres to increased 
activity. 

When the bath is too prolonged the result of over-stimulation 
ensues, and the depression of the nervous system and circulation 
may be sufficiently severe to interfere greatly with normal functional 
activity. 

Just at this point it becomes clear why persons " catch cold," or, 
more technically speaking, are attacked by local or general conges- 
tions. One person who is weak may never reach the stage of stimu- 
lation of which we have just been speaking, because his system has 
not enough units of force in it to unite and expend them upon 
the functional activities named, and, as a consequence, the blood, 
which at the first shock has hurried into the internal viscera, is not 
driven back to its duty, but, sulking in its retreat like a deserting 
soldier, allows disaster and disease to ensue because its superior 
officer, the central nervous system, cannot gather together enough 
force or authority to make it do its duty. These cases present evi- 
dences, therefore, of circulatory and systemic depression or have con- 
gestion of the lungs, liver, or other parts. In the strong person 
exactly the same state of affairs obtains in the third stage of depres- 
sion, but only after the strength of the system has been expended in 
the activity of the stage of exhilaration. 

Cold salt baths, particularly if they are sea baths, are more stimu- 
lating and not so relaxing as is fresh-water bathing. 

Cold effusions to the head, and, better still, the use of an ice-bag, 



COLD AS A REMEDY. 371 

have long held a high position in the treatment of meningitis and head 
injuries, and a hot bottle to the feet and cold to the head will often 
cause sleep in persons who habitually suffer from insomnia. This is 
particularly the case with those persons who have wakefulness from 
mental overwork. On the other hand, cases with insomnia from 
cerebral anaemia do well if a cold plunge-bath is taken before going 
to bed, although in still other cases a hot bath is more efficacious. 
(See Heat.) The latter instances are not due to anaemia, but to ner- 
vous irritability, which the heat quiets, whereas the insomnia of cere- 
bral anaemia is relieved by a cold plunge by reason of the increased 
circulatory activity produced by the bath. 

When cold is to be applied to the head continuously, it is often 
convenient to employ a coil made of rubber tubing and so shaped as 
to fit the vertex. One end of the tubing should reach to a tub of 
cold water on one side of the bed and the other to an empty tub on 
the other side. By sucking on one tube siphonage is established, 
and as soon as the liquid has been transferred from one tub, the 
stream may be reversed and the water passed back again to its former 
receptacle. 

The use of a cold bath after a person becomes heated is popularly 
supposed to be dangerous. On the contrary, every athlete knows 
that nothing is so refreshing and so preventive of muscular stiffness 
after severe exercise and sweating as a cold plunge- or shower-bath ; 
but he also recognizes the fact that a plunge is all that is permissible, 
and it is only the person who possesses the healthy circulatory power 
which will enable him to rebound from momentary depression to 
increased activity that should resort to such procedures. 

Cold water dashed or sopped against the perineum or the scrotum 
and the lumbar region is a favorite remedy for nocturnal seminal 
emissions with some practitioners, and the scrotum may be submerged 
in a tumbler of cold water for a few minutes at night for a similar 
purpose. 

A very useful treatment of dysentery is to gently inject into the 
rectum about one or two quarts of cold water — if necessary it may be 
icy cold; and a similar application for piles is a useful adjunct to all 
forms of treatment for these troublesome formations. 

So highly do some physicians praise this method that the writer 
has thought it proper to quote from a paper of Dr. J. William White 
upon this subject. He says : 

u I desire to call the attention of the profession to a method of 
treatment which, although not altogether new, is yet not appreciated 
as, in my judgment, it should be. I refer to a moderately forcible 
stream of water of varying temperature in the treatment of a number 
of affections of the rectum, anus, and genito-urinary apparatus. The 
tonic and astringent effect of such a stream of water upon any living 
tissue is, of course, a well-understood fact, and has been employed in 
the arrest of hemorrhage, in the treatment of inflammation, and in 
various conditions. But it has only been in exceptional cases, and 
usually by the aid of more or less troublesome apparatus, that it has 
been used in the class of cases to which I now refer. 



372 REMEDIAL MEASURES OTHER THAN DRUGS. 

" The bidet, as I have now for a few years prescribed it, should be 
of the variety which can be attached to the water-closet seat habit- 
ually used by the patient. It should have a nozzle capable of throw- 
ing a stream of about the calibre of an ordinary lead-pencil or a lit- 
tle less. The head of water should be sufficient to make it impinge 
upon the parts exposed to it with enough force to excite there a little 
sensation of smarting or tingling. That degree of force will, for 
example, be sufficient to enable the patient to take an enema, or, if a 
female, to take a vaginal injection. The bidet pipe should be mov- 
able by means of a handle, so that the stream can be directed against 
any portion of the external genitals, the perineum, the anus, or the 
surrounding parts. It should also have connection with the hot and 
cold water-supply of the house, so that the water may be used of any 
temperature which the physician may prescribe or which the sensa- 
tions of the patient may make desirable. Stopcocks should regulate 
the size and force of the stream, and should be so placed as to be 
easily reached by the hand of the individual sitting upon the water- 
closet seat. Such an apparatus can be put in place by any experienced 
plumber in any ordinary water-closet at an expense of from fifteen to 
twenty dollars, and, in Philadelphia at least, the usual head of water 
obtainable even in third-story rooms is quite sufficient for all thera- 
peutic purposes. 

" The diseases in which it may be desirable to use this method of 
treatment may be divided into two classes : First, those affecting the 
lower end of the bowel and its outlet ; second, those involving the 
genito-urinary system. Among the first the most important are hem- 
orrhoids, internal and external, prolapsus ani, and slight cases of 
prolapsus recti ; pruritus ani and eczema of the margin of the anus 
should also be included in this group of cases, in which it has now 
for some time been my habit to prescribe the systematic employment, 
twice daily, of the bidet, one immediately after the daily stool, and 
for the second time, by preference, just before going to bed. As a 
rule, in all the midwinter months the ordinary temperature of the 
Schuylkill water is that to be preferred, although I am largely gov- 
erned by the feelings of the patient in this respect. An enema 
should be taken at each of these times, the lower portion of the rec- 
tum being thus thoroughly washed out at least twice daily, after 
which the stream of water is allowed to play upon the affected region 
for a period of from five to fifteen minutes. The ordinary and useful 
effect of cool sponging or washing immediately after stool in cases 
of hemorrhoids is by this means enormously increased. Internal 
hemorrhoids will, under this treatment, in many cases almost 
entirely disappear, unless they are exceedingly large and have 
been frequently inflamed or strangulated and badly neglected ; 
external hemorrhoids, even when fleshy, will shrivel and become 
scarcely noticeable. 

44 1 could detail a number of cases of this character taken from my 
practice of the last two years. In some instances in which I had been 
habitually called in, at intervals of a few months, in the case of old 
people, the result has been practically their disappearance from my 



COLD AS A REMEDY. 373 

list of patients ; and they speak in the warmest manner of the great 
comfort derived from this simple method of treatment. 

" Perhaps nothing is more distressing among minor affections than 
the trouble described as pruritus ani, and variously attributed to liver 
disease, constipation, gastric troubles, latent gout, uterine disease, 
parasites, neuroses, and a number of other causes, varying from eat- 
ing of shell-fish or excessive smoking to alleged hereditary predis- 
position. There are very few practitioners of any experience who 
have not discovered how difficult it is in any particular case of pru- 
ritus to assign distinctly the annoying symptoms to any one of these 
causes. Often the whole list may be carefully gone through and 
eliminated, or the proper remedies may be applied successively, as 
different theories are adopted, without the slightest benefit resulting. 
Ointments, lotions, and ordinary cool bathing will be tried in great 
variety, but without avail, and such patients will often go from one 
physician to another or fall into the hands of quacks while seeking 
proper professional relief. My list of cases of this character which 
I have now treated by means of the ' bidet ' comprises eight. 

wt Nearly all my cases have resulted in cure, requiring to attain 
that end simply different lengths of time of the application of the 
douche, with variations of the temperature of the water and occasion- 
ally the use of some emollient salve. I have been particularly struck 
by the fact that these cases include among their supposed causes 
widely distinct conditions, and the uniformity with which they have 
yielded to this simple treatment has led me to regard with suspicion 
the orthodox etiology of the disease. In procidentia ani and in slight 
cases of prolapsus recti I have had very satisfactory, though of course 
less striking, results. In a few instances the trouble almost entirely 
disappeared, and in all of them it was distinctly relieved. These cases 
require for their successful treatment a much longer application of the 
douche, and the water should, in my judgment, be at one or the other 
extreme of temperature — either quite cool or as hot as can be com- 
fortably borne. 

" I am quite aware that the use of cold water in these affections is 
not in the least a novel plan of treatment ; but the method under 
consideration combines the effects of temperature with a sufficient 
force of the stream, and admits of the prolonged application of the 
remedy without effort on the part of the patient, who is in the most 
suitable position for this treatment — practical points which induced 
me to make this mention of my results in rectal and anal cases. 

" Agnew says of pruritus that among the local remedies frequent 
ablutions with cold water should be mentioned, and of prolapsus ani 
et recti that ' in all cases where remedies have proved unavailing, or 
where patients have declined an operation, much good may be done 
by douching the parts with cold water and applying an oiled com- 
press;' and Allingham says of the same class of cases that 'the fre- 
quent and bountiful application of cold water is to be most strongly 
recommended ;' but few authors, so far as I know, have especially 
alluded to the method of application by means of a bidet. 

"My second class of cases includes, chiefly, certain prostatic 



374 REMEDIAL MEASURES OTHER THAN DRUGS. 

troubles, varicocele, atonic impotence in the male, and pruritus of 
the vulva or vaginitis in the female. In case of variocele, although 
I have not succeeded in effecting a cure in any instance by this 
method, I have certainly seen advancing enlargements of the sper- 
matic veins becoming stationary, long relaxed and pendulous scro- 
tums become firm and much smaller, and the mental condition of the 
patient, which is so important an element in many of these cases, 
shares in the improvement. In chronic prostatitis, a most intractable 
and distressing ailment in many instances, it has come to be a part 
of my routine treatment to order the use of cold perineal douches by 
means of the bidet, associated with frequent cold enemata given in 
the same manner ; and I believe to-day that if I had to discard all 
therapeutic measures but one in these cases, I would retain this one. 
In a certain number of cases of impotence associated with general 
muscular weakness, loss of tone, lack of general strength and vitality, 
accompanied by imperfect or rapidly-subsiding erections, I have found 
that the cold douche applied with some force and for considerable 
lengths of time to the perineum and testicles has been productive of 
marked benefit. 

" In two cases of pruritus vulvae my results have been good, 
though less striking than in similar disease affecting the region of the 
anus. In vaginitis, where the woman has sufficient intelligence to 
learn how to take an injection by means of the bidet, it offers an 
admirable method of cleansing the vagina, of carrying away thor- 
oughly all accumulated secretions, of reducing heat and swelling, and 
at the same time of avoiding the frequent introduction into the 
inflamed canal of a foreign body in the shape of the nozzle of a 
syringe. My opportunities for observation in this class of cases have 
been limited, owing to the disinclination of these patients to procure 
the bidet, and owing to their irregular habits of life and their fre- 
quent changes of residence ; but I have seen enough of its good 
results to make me feel confident that it is a valuable addition to 
our therapeutic agencies. 

"After all, in every one of the cases which I have mentioned its 
use is simply the application of the most elementary and common- 
sense principles to every-day practice, but I am satisfied that this 
particular method of applying these principles has not received the 
attention which it merits." 

Cold in Fevers. 

The proper manner to employ cold water in fever should be thor- 
oughly understood. It may be used at a number of temperatures, 
according to the effect desired, such as cool, moderately cold, and 
very cold. 

Very commonly in the course of a fever the patient is restless, 
uncomfortable, and sleepless, yet has not a temperature fraught with 
any harm. Such a case may be sponged off with tepid water or with 
a little alcohol and water, or salt and whiskey, with great benefit in the 
production of sleep, the reduction of fever, and the advantage of ner- 



COLD AS A REMEDY. 375 

vous quiet. Sometimes the sponging is successful when used only 
over the arms and legs, but more frequently it should be extended at 
least to the spinal column. 

If tepid sponging does not lower the fever in a given case, then 
ordinary cool tap-water should be employed ; and it is well to remem- 
ber that the secret of successful sponging lies in the use of a sponge 
not saturated to overflowing, but only sufficiently wet to leave a thin 
film of moisture on the skin, which cools the patient by its rapid 
evaporation and does not wet the clothes and the bed. 

There are many cases where sponging, even with ice-water, fails 
to reduce the fever, and in these the fever must be lowered by the 
"cold pack," as it has been called. The name is unfortunate, as it 
is indicative of a very severe exposure, which really does not occur. 
The application is carried out as follows : 

A small canvas cot should be placed by the side of the bed of the 
patient and covered by a large rubber cloth, which, by being raised 
at the head and depressed at the foot, forms a channel for the water. 
Over this, again, is placed an ordinary sheet. The patient, after 
being stripped, is laid upon this sheet, which is then folded over him, 
and a fine spray from an ordinary watering-pot for flowers allowed to 
play upon his body from end to end. The temperature of the water 
depends upon the effect required. The bed should be so arranged 
that the water will not remain in puddles under the patient, but drain 
off constantly into a bucket at the foot. The sheet being wet allows 
evaporation to go on, and a rapid fall in the fever results. 

It is of the greatest importance that the attendant lightly but 
briskly rub the patient all over with the hands, so as to bring the 
blood to the surface and prevent internal congestions. 

During this procedure the thermometer should be placed in the 
mouth or pushed deeply into the rectum, and the fall in the tempera- 
ture watched. As soon as it reaches 101° or 100° F. the bath must 
cease, lest the fall continue and collapse ensue. 

On the lemoval of the patient the surface should be gently dried 
with towels, and the bed-clothing consist of only a sheet, or a sheet 
and one blanket in cold weather. Above all things, it must be remem- 
bered that the patient is not to be wrapped up in a blanket, and not 
only this, but that he must not be placed in a blanket while still in a 
wet sheet. The wet sheet, if surrounded by a blanket, soon places 
the patient in a typical Russian or warm moist bath, calculated to 
to raise instead of lower the fever. 

Where sunstroke (thermic fever) is present the patient may have 
chopped ice applied or be put directly into a bath-tub of ice-water, 
but in any event the attendants must rub the patient's skin to bring 
the hot blood to the surface and prevent congestions. Cold water 
may also be injected into the bowel in cases where the skin is cold, but 
the central temperature very high. (See Enteroclysis.) 

The treatment of rheumatic hyperpyrexia by cold is quite as suit- 
able as is this treatment of other fevers whenever the hyperpyrexia 
is so excessive as to endanger life. 

The presence of pneumonia and bronchitis does not contrain- 



376 REMEDIAL MEASURES OTHER THAN DRUGS. 

dicate the use of cold in fevers, and no fear of " cold being taken " 
need exist unless the bodily temperature is lowered below the nor- 
mal point or to one degree above it. According to Liebermeister, 
intestinal hemorrhages contraindicate the use of cold, but this state- 
ment has been contradicted by no less a writer than Wunderlich. 
(For Brand's cold treatment of typhoid fever see Typhoid Fever.) 



COUNTER-IRRITATION. 

Counter-irritation is a term applied to the use of substances irri- 
tating to the surface with which they come in contact, and employed 
for the purpose of influencing morbid processes in more or less dis- 
tant parts or of affecting the general system. It has been thought 
that this method savors of the doctrine of "like cures like," but in 
reality it is based on sound physiological laws, and is so logical as to 
have been described by the founder of homoeopathy as useless. 

The entire basis for the employment of counter-irritation rests 
upon reflex action, or the conduction of a nervous impulse to a centre, 
which, when so stimulated, sends out an impulse to the part of the 
body which is diseased. 

The use of counter-irritation may be divided into four parts or 
purposes : The first is for affecting inflammations or congestions ; the 
second for causing the absorption or removal of inflammatory depos- 
its after true inflammation has ceased ; while the third purpose is for 
the relief of pain ; and the fourth for the effect which can be exer- 
cised upon the general S} r stem by blisters in systemic disease. 

In the same manner that we can divide the indications for coun- 
ter-irritation into four parts, so can we also divide its forms into three 
varieties, according to their severity. The most severe are the caus- 
tics or escharotics, the next the epispastics or blisters, and finally the 
rubefacients or reddeners. 

The proper manner of employing a counter-irritant to affect inflam- 
mations is not to apply it directly to an actually inflamed area, but a 
little to one side of it or at a spot known to be connected intimately 
with the diseased area by nerve-fibres. 

Thus, it is well known that in diseases of the eye the blister 
should be applied back of the ear, and that in abdominal neuralgia 
or in pleurodynia the best results are reached, not from the applica- 
tion of a blister to the spot where the pain is felt, but to the point 
upon the vertebral column where the nerve at fault takes its exit. 
The reason for this is that pain is always referred to the peripheral 
end of an irritated nerve, and pleurodynia or abdominal pain often 
arises from vertebral disease or inflammation about the spinal liga- 
ments or the foramina of exit for the nerves. In a similar manner 
we sometimes apply a blister, in the early stages of hip disease, not 
to the knee or ankle, where the pain is felt, but at the seat of the 
trouble — namely, the hip. Counter-irritation is contraindicated by 
the presence of any acute inflammation directly under the spot w T here 
it is proposed to place a blister ; that is, if any reddening of the skin 



CO UNTER-IRRITA TION. 377 

is present the blister or other form of irritation must not be applied 
there. If used at all, it must be some little distance away, or a series 
of small flying blisters should be placed around the inflamed zone. 
A flying blister is one which is small in area — say as large as a Lima 
bean — and of comparatively slight action, healing rapidly after its 
effects have passed by. 

Among the inflammatory affections in which we find counter-irri- 
tation very serviceable may be mentioned pleurisy, pneumonia, iritis, 
synovitis (rheumatic or traumatic), cerebritis, and peritonitis (acute 
or chronic). A host of more subacute or chronic inflammations are 
also benefited by this measure, some of which are gleet, chronically 
enlarged joints, and inflamed glands. In all these states the blister, 
or more rarely the rubefacient, is to be resorted to ; and while it is 
true that nearly all of these conditions are accompanied by fever, and 
that fever is generally held to be a contraindication to the use of 
counter-irritation, blisters undoubtedly do good at such times. In 
pneumonia or pleurisy, along with the use of veratrum viride in the 
very earliest stages of the disease, a cantharidal blister of the size 
of a silver dollar should be applied near the spot where the most pain 
is felt or on the back near the spine. Where joints are inflamed 
the blisters should be at some distance from the seat of the swelling, 
although it is often useful to place the counter-irritant on the inner or 
outer aspect of the knee-joint if the skin is not reddened. In peri- 
tonitis the blisters are best applied directly over the seat of tender- 
ness, and in cerebritis at the nape of the neck. In gleet a little can- 
tharidal collodion may be painted alon^i the under surface of the penis 
or upon the perineum with great advantage in obstinate cases. 

Where inflammation is chronic and resists cantharidal blistering, 
then resort is often had to more severe forms of counter-irritation by 
means of the red-hot — not white-hot — iron, or the use of escharotics, 
such as caustic potash or soda or arsenic. The reason for using 
these is that they all cause so much tissue-change in the part that the 
counter-irritation is very prolonged, Sometimes antimonial ointment 
is applied constantly until a slough forms, to accomplish the same 
purposes. 

For the removal of the products of inflammation we resort to can- 
tharidal blisters or drugs possessing powers as local irritants and at 
the same time as alteratives. Thus, in pleurisy with effusion it is 
very proper to employ a good-sized cantharidal blister if the effusion 
has a tendency to remain unabsorbed. Some have thought that the 
absorption which follows is due to the abstraction of serum which 
takes place in the bleb formed, but this is a mistaken idea, as one 
often sees an effusion absorbed which far exceeds in quantity the 
amount of liquid in the blister. Under these circumstances the spot 
for applying the blister is, as a rule, immediately under the arm, 
about two or three inches below the axilla. The blister, while it is 
useful in causing absorption in chronic effusions and deposits about 
joints, is not so good as are alterative irritants; for example, iodine, 
which in the form of a thorough application at one sitting until the 
skin is black — not vellow or red — is often of service. In other cases. 



378 REMEDIAL MEASURES OTHER THAN DRUGS. 

particularly in very chronic states, iodine ointment, alone or with 
lard, may be rubbed into the parts with advantage, care being taken 
to stop its use for a day or two as soon as the skin gets red. This 
same treatment is also useful in treating enlarged glands in the neck 
and elsewhere. 

One of the best treatments for epididymitis is to paint the scrotum 
black with many coatings of a strong solution of silver nitrate or 
iodine, to insist on total rest in bed, and to resort to the local use of 
cold. The testicles should also be supported by a suspensory or 
adhesive strips during this treatment, and aconite given if fever is 
present. 

For the relief of pain we very commonly resort to the rubefacients 
rather than epispastics, since the more moderate applications are 
equally effective in most instances, and do not leave evil effects 
behind to remind the patient of his attack. 

Every one who has had stomach-ache and remembers the relief 
obtained by the use of a mustard plaster or spice plaster recognizes 
the value of this means of obtaining relief, and it only remains for 
the writer to state that headaches are often amenable to similar treat- 
ment. These headaches may be neuralgic or due to dyspepsia or to 
cerebral anaemia or congestion, but counter-irritation will neverthe- 
less do good. If neuralgic, a little menthol or oil of peppermint 
may be applied over the course of the nerve — which application, if 
the pain be supraorbital, will require care lest the oil gain access to 
the eye. 

For the treatment of pain in the belly or chest or elsewhere we 
have four means of producing counter-irritation in the shape of rube- 
facients : The first is mustard ; the second, capsicum ; the third, the 
turpentine stupe ; and the fourth, the spice poultice. 

The mustard plaster should be made by mixing mustard flour with 
warm vinegar or water, and adding varying proportions of ordinary 
flour to modify its action. If the skin is tender, half mustard and 
half wheat flour may be employed, or if a child is to be treated the 
proportion may have to be only one-fourth mustard. The plaster is 
made by placing a stout piece of paper on a table and putting over 
it a piece of heavy muslin or linen. On this is smeared the mus- 
tard, and over the mustard mass is placed a thin piece of linen, 
which prevents the poultice from adhering to the skin and modifies 
the burning according to its density. By folding the edges of the 
paper so that it resembles a picture-frame Ave have at a hand a cheap, 
effective, and strong plaster, the back of which is supported by the 
paper. 

The spice plaster is made by mixing equal parts of allspice, cloves, 
cinnamon, and nutmegs, and adding thereto one-half part of black 
pepper. These constituents are made into a homogeneous mass by 
using a knife-blade to mix them, and are. then sewed up in a bag 
which is quilted to prevent sagging of the contents. One side of the 
poultice is now wetted with warm brandy, whiskey, or vinegar, and 
applied to the part desired. 



DISINFECTION. 379 

If the skin is tender the proportions of pepper and cloves should 
be decreased. 

This plaster may be allowed to remain over the affected parts for 
hours or even days, and is very useful in the treatment of gastric 
catarrh and indigestion, particularly that occurring in children. 

The turpentine stupe (see Turpentine) is not to be allowed to 
remain very long on the skin, as it may blister a tender cuticle r and 
the pepper plaster may be so active as to produce unbearable pain if 
it is not watched. 

The proper way of treating all such burns from counter-irritation 
is to apply simple cerate, cosmoline, or sweet oil, to which may be 
added carbolic acid in the proportion of 1 : 100. The carbolic acid 
not only acts as an antiseptic, but as a local anaesthetic, while the oil 
acts as a protective from contact with the air. 

Much difference of opinion exists as to the proper treatment of the 
blister formed by cantharides. Where the blisters are small — that is, 
the size of the end of a finger — they may be allowed to break of them- 
selves, and then be dressed with dry cotton ; if they are large, the 
blebs should be punctured at their most dependent part with a needle 
and dressed with dry absorbent cotton, as by so doing the new skin 
rapidly forms underneath and is soon able to carry on its normal 
functions. 

The proper treatment of the blister while it is forming is to apply 
a poultice, which will decrease the pain and aid in the formation of 
the bleb. 

DISINFECTION. 

Before discussing the subject of Disinfection, we must turn our 
attention to what we mean by the terms employed when speaking of 
this subject in general. At present we recognize that the word germ- 
icide is a term applicable solely to agents capable of killing the lower 
forms of life, whereas antiseptics are substances which simply render 
the material with which they come in contact so antagonistic or 
unsuited to germ-development as to render their presence for any 
length of time impossible, at least in an active state. To use a simile : 
the killing of the inhabitants of a district by shooting them would stop 
all growth and be germicidal, whereas the destruction of crops in these 
same parts would only be antiseptic ; or, in other words, the people 
might remain, but would have to starve to death. (See article on 
Antiseptics.) 

We now speak of germicides as disinfectants, but never of anti- 
septics as disinfectants if we use these terms correctly. "Germicide " 
and " disinfectants " are therefore synonymous words. 

From what has just been said it is evident that we should always 
resort to disinfectants rather than antiseptics, for although the latter 
are good, the former are better. 

We have three ways of destroying germs which are particularly 
useful : The first is the total destruction not only of the germs, but 
also of their resting-place, by means of fire, which may be used in 



380 REMEDIAL MEASURES OTHER THAN DRUGS. 

the case of old furniture, mattresses, and similar materials, and which 
may be extended to everything about the patient if it is necessary to 
stamp out a brisk epidemic before it can get well under way. The 
second is the use of moist heat in the form of superheated steam, or, 
better still for common purposes, the use of boiling water ; and, 
thirdly, by means of disinfectant materials which have a proved 
reliability. 

Moist heat in the form of superheated steam is infinitely prefer- 
able to dry heat, but as superheated steam cannot be readily obtained, 
physicians usually direct the clothes to be boiled for at least two 
hours. 

Very often the bed-clothes are taken from a sick-room, trailed 
through the house, and finally deposited at any spot until a conve- 
nient time for boiling them occurs. This is radically wrong and capa- 
ble of causing a widespread distribution of the disease. In all such 
cases the bed-clothes should be rolled off the bed in a bundle and com- 
pletely submerged in a bucket or tub of boiling water, or, better still, 
in a corrosive-sublimate solution of the strength of 1 : 1000, before 
they are taken from the room. This tub is now to be carried at once 
to the fire, and the clothes lifted out dripping wet and plunged into a 
clothes-boiler in which the water is actively boiling. The lid of the 
boiler is at once to be put on to increase the heat and prevent the 
escape of any germs in the steam or in the hot air which arises from 
the surface of the water. The active boiling should be continued for 
one or two hours, and water be continually added to prevent scorch- 
ing of the contents of the boiler. 

It is important that food be not cooked on the stove at the time 
the clothes are being boiled, and no food should be in the room. 

If boiling cannot be resorted to for any reason, the clothes may be 
soaked in a 1 : 500 solution of corrosive sublimate or a 1 : 20 solu- 
tion of carbolic acid, although neither of these is so sure a method of 
disinfection. 

The proper care of a room after it has been occupied by a case of 
infectious disease is of great importance, and is generally sadly mis- 
managed. Very commonly sulphur is burnt, and this, as usually 
employed, is perfectly useless, owing to leaking windows and doors, 
which permit most of the generated gas to escape. 

To be of any value the burning of sulphur must be preceded by 
packing the window- and door-cracks with cotton or soft paper. 
Broken roll-sulphur is moistened with alcohol, which is then lighted. 

By far the best method of disinfection is to take all movable objects 
out of doors into the fresh air, and then to wash the floor, sills, and 
a scrubbing-brush, hot water, and soap. The water 
the bucket should afterward be boiled to kill the germs 
which may be in it. This scrubbing being accomplished, the same 
surfaces should be scrubbed a second time with a solution of corrosive 
sublimate (1 : 500 or 1 : 1000), and left wet, so that the salt of mer- 
cury may remain on them. Cracks and crannies are to receive par- 
ticular attention. If corrosive sublimate cannot be used, then car- 
bolic acid (1 : 10 or 1 : 20) may be resorted to. 



ENTEROCLYSIS. 38 J 

By far the best disinfectant for all diseases is good ventilation. 
Not only should as much air as possible be allowed to enter the sick- 
room, but after the case has vacated the premises the windows should 
remain open for weeks if possible. Fresh air dilutes germs as fresh 
water dissolves or dilutes dirt. 

Disinfection of the discharges of the patient is an important duty 
to be remembered. The urine and faeces should always be received 
in a vessel containing enough corrosive sublimate solution (1 : 500) 
to kill all germs, and to prevent their escape into the air or into 
water or food when the discharges are thrown away. * The disinfect- 
ant should be placed in the bed-pan before, not after, it is used. 

The bed-pan or chamber should not be allowed to stand in the 
room, but be removed and emptied at once in such a manner that it 
cannot contaminate any water or food. Its contents should not be 
thrown upon the ground, as the air will dry them and cause the germs 
to fly in the form of dust anywhere and everywhere. In very con- 
tagious diseases bathing or swabbing off the patient with Aveak anti- 
septics may be tried. Thus 1 : 10.000 of bichloride of mercury may 
be used and the patient afterward wiped off with a wet towel. 

The question as to which are the best disinfectant substances is 
one which has attracted the attention of physicians and original inves- 
tigators for years. The result of a vast amount of study and experi- 
ence shows that corrosive sublimate is the best of all disinfectants in 
the proportion of 1 : 250 to 1 : 500, or even weaker, and that for 
cheapness, activity, and general usefulness chlorinated lime is better 
still. The disadvantages in the use of corrosive sublimate lie in its 
ready decomposition, its formation of an albuminate when albumin 
is present, its uselessness where lead pipes are present, and, above 
all, its expense. Chlorinated lime depends entirely upon its chlorine 
for any disinfectant power which it may possess. Chlorine gas itself 
is not readily handled, but the lime enables us to put it where we 
will. It cannot be employed to disinfect colored fabrics, as it bleaches 
them. 

Whenever chlorinated lime is bought the physician should see that 
all its chlorine has not departed from it, as most of the material kept 
in the stores is so old as to be worthless. 

For scrubbing floors, chlorinated lime may be made into a solution 
by adding a cupful to a bucket of water, and in privies it may be 
spread thickly over the surface of the mass of filth. 

It is useless to place chlorinated lime around the room for the pur- 
pose of disinfecting the air, as the amount of chlorine to the volume 
of air to be disinfected is as nothing. 

Copperas, or sulphate of iron, while largely used as a disinfectant 
by some persons, is in reality only an antiseptic. 



ENTEROCLYSIS. 

Enteroclysis, or the washing out of the bowel by means of large 
and slowly injected clysters for the purpose of medicating or cleans- 



382 REMEDIAL MEASURES OTHER THAN DRUGS. 

ing both the large and small intestine, has within the last few years 
become one of the most valuable therapeutic measures we possess. 
Not only is it of value for the purposes named, but for the relief of 
intestinal obstruction, for the preservation of bodily heat by the use 
of hot water, and for the reduction of fever by the use of cold water. 

The treatment of choleraic diarrhoea in all its forms by enterocly- 
sis was first used by Cantani within the last decade. The method 
yielded such good results in his hands that he enthusiastically 
employed it in a large number of cases, and caused a number of 
other physicians to use it. The method consists in the slow irri- 
gation of the large and small bowel by way of the rectum by means 
of a solution urged on by the hydrostatic pressure of a fountain- 
syringe. The solution contains as its chief constituents tannic acid, 
which is added in the proportion of from 1 to 5 drachms to 2 quarts 
of water, with 1J ounces of wine of opium. 

Carbolic acid is too poisonous, salicylic acid too insoluble, corro- 
sive sublimate too poisonous and too easily decomposed, to be used in 
this manner. 

In some cases Cantani employed a mixture made of 

Infusion of chamomile-flowers ...... 2000 parts. 

Tannic acid 10 " 

Gum arabic 30 " 

Tincture of opium 2 " 

Cantani considers that the passage of the ileo-csecal valve is essen- 
tial for the success of his methods, and if this is the case the report- 
ers who have failed to obtain satisfactory results from this treatment 
have probably failed to do more than irrigate the colon. The import- 
ance of irrigating the ileum is great, since it is in this portion of 
the alimentary canal that the cholera germs are most active. Bela 
Angyan of Buda-Pesth in 1886 treated 76 cases of choleraic diarrhoea 
with 76 recoveries, 85 cases of cholerine with 85 recoveries, 90 cases 
in the algid stage of true cholera with 58 recoveries, and 211 in a far 
advanced stage of asphyxia with 44 recoveries and 167 deaths. Nor 
is this treatment by tannic-acid injections founded upon mere em- 
piricism, for Cantani and others have found that tannic acid, in the 
strength of 1 per cent., inhibits the growth of intestinal germs in one 
and a half hours at 98° F., while J per cent, in six hours seriously 
impairs their vitality. Cantani also asserts that tannic acid neutral- 
izes the toxines formed by these micro-organisms. This treatment 
therefore contracts the leaking blood-vessels, stops the growth of the 
bacilli, prevents the absorption of toxines, acidifies the intestine, 
stimulates the nervous system, warms the body, prevents anuria, and 
avoids collapse. 

The employment of irrigation of the colon in cases of dysentery 
is by no means of recent date. It is only, however, within the last 
few years that this method of treatment has been widely employed or 
considered. Aside from the fact that we can bring medicaments in 
direct contact with the diseased mucous membranes, there is no doubt 
whatever that the mere passage of water at suitable temperatures 



ENTEROCLYSIS. 383 

over the bowel-wall is of value, since by this means we remove mucus 
and pus, and so dilute the poisons manufactured by the germs of 
the disease that their further action is largely inhibited. That 
the irrigation treatment is of value has been shown by Johnston of 
Washington, who in a recent paper details exhaustively the advan- 
tages accruing from this practice and the harmfulness of opium, par- 
ticularly by suppository. This drug, though temporarily causing 
a decrease in the stools, ultimately increases the trouble by locking 
in the bowel the very material which we wish removed. As Johnston 
well points out, our sole object is to keep the colon and rectum clean. 
If this can be done without the use of antiseptics in the fluid injected, 
so much the better. In adults the use of irrigation in dysentery should 
be carefully carried out by means of an inflow and outfloAv tube, the 
first being attached to a fountain-syringe. The outflow tube must be 
large enough to permit of the liquid leaving the bow T el with a readi- 
ness equal to that of its inflow, and must be so straight and patulous 
as to permit of the fluid carrying away with it any flakes of mucus 
or other foreign matter from the bowel. The method employed in 
giving the injection, the temperature of the water, and the gentleness 
of the operation are exceedingly important, and will be discussed on 
the succeeding page. The amount of water employed in irrigation 
of the bow T el in dysentery is not to be measured by quarts, but by 
results. It should continue to flow in until it comes from the out- 
flow T tube perfectly clear, showing that our object — namely, thorough 
cleansing of the bowel — has been accomplished. The best medica- 
ment to be added to the water is boric acid or tannic acid, each of 
which is harmless and capable of doing much good. 

The question as to what is the best method of treating a case of 
intestinal obstruction by other than operative means is one which is 
of interest to the physician as well as the surgeon. Such cases gen- 
erally come into the hands of the general practitioner first, and it is 
for him to decide, as a rule, whether the surgeon shall be called in 
consultation. Measures devoted to the relief of the patient without 
the use of the knife are first to be tried. No one who has studied 
this subject can doubt that enteroclysis is the best form of treatment 
which we can apply. Used properly, there is little danger of its 
doing harm, and much chance of its accomplishing good. The author 
is not one of those who place much confidence in the reports of cases 
of volvulus overcome by this means. The true indication for rectal 
injections is intussusception or obstruction due to impacted faeces. 

A very important point to be decided in connection with this sub- 
ject is the amount of pressure that can be used in the stream of water 
Avhich is employed, the length of time during which the injection may 
be given, and, finally, the temperature and character of the fluid 
injected. While it is true that most physicians have a general idea of the 
correct thing to do under these circumstances, experience shows that 
when the case stares one in the face the minor points connected with 
the treatment are not to be ignored. As is w T ell known, the great 
majority of cases of intussusception take place at the ileo-csecal valve, 
and, if not here, in the sigmoid flexure. Pressure by injection is 



384 REMEDIAL MEASURES OTHER THAN DRUGS. 

therefore readily brought to bear on the area involved. A moment's 
recollection will show that rectal injections are generally performed 
not only with force, but with rapidity ; but this is wrong, as clinical 
experience and experiments made by Dr. Martin and the author 
have proved. It has been claimed that certain pressures will cause 
rupture of the peritoneal coat of the intestine, but we failed in 
the dog to produce this lesion by any pressure we could employ, 
since before this occurred the liquid passed through the stomach 
and mouth. To employ a pressure exceeding eight pounds is, how- 
ever, distinctly dangerous, not because the intestinal wall in health 
will not stand this, as a rule, but because it is near the injury 
line, and if any disease or softening of the bowel exist, it is almost 
certain to cause rupture. A pressure of from two to five pounds 
is, as a rule, as much as may be employed, and this pressure should 
be obtained by degrees, starting the injection at such a point of pres- 
sure that it amounts to hardly more than a trickle, and increasing 
the pressure as the antagonism of the bowel is overcome. Finally, 
when the bowel is fully distended up to the point of obstruction, 
the pressure on the no longer moving column of water may be 
increased, if necessary, to. six or eight pounds by raising the bag of 
water. In infants, in whom invagination so often occurs, a pressure 
greater than two pounds is dangerous, and it is of vital importance 
that the pressure be employed properly, otherwise it will do more 
harm than good in several ways. As a rule, in our anxiety to give 
the patient relief at once we are inclined to use too much force and 
too large a bulk of water, and think that active force, if such a term 
may be used, is to be resorted to. Those Avho have seen these cases 
have learned by experience the harmfulness of such measures, and 
have also learned how great is the expulsive power of the bowel 
when it is excited to contraction. If this power be brought into 
activity, it will be almost impossible to inject fluid into the rectum, 
and, worse than all, the muscular fibres of the intussuscipiens take a 
still tighter grasp on the intussusceptum. 

In order to determine the exact amount of pressure permissible in 
such cases, Dr. Martin and the author carried out a series of experi- 
ments, and found from the very first that the force exercised is a com- 
paratively unimportant factor compared with speed — that is to say, an 
injection of two quarts of water, made very slowly, was less apt to 
cause intestinal opposition than one pint rapidly sent into the gut. 
This is, perhaps, the most important point to be remembered. The 
dangerous practice of using a Davidson or any other kind of artificial- 
force syringe in the treatment of this class of cases is to be con- 
demned. Three unreported cases of rupture of the bowel and death 
from the employment of the Davidson syringe for this purpose have 
occurred, because the amount of force used was indeterminable, and 
because it was injected with a jerking instead of a constant flow. The 
amount of fluid injected should be large, and if it is impossible to get 
a large amount into the bowel, it is probably because the inflow has 
been so rapid as to excite intestinal opposition. If, by a slow trickle 
of water into the bowel, gradually increasing the pressure, we are 



HEAT. 385 

unable to give relief in forty-five minutes, it is necessary either ij> 
give this treatment up as useless, or else allow the liquid to flow away 
and resort to the measure again in some hours. Practical experience 
has shown that the second or third injection sometimes succeeds, prob- 
ably because it is more skilfully given and the first has prepared 
the way for the others, but it is to be remembered that the chances 
for reduction of the obstruction are best with the first injection if it 
is properly given. Frequently-repeated small injections are abso- 
lutely unjustifiable. 

Finally, the author cannot leave this subject without saying a word 
concerning the temperature of the injected liquid and its constitution. 
An injection of this kind goes into the very heat-citadels of the body,, 
and if too cold, as it often is, produces dangerous chilling of organs 
which are ordinarily especially protected from cold by the omental 
apron and intestines. By repeated experiment we found that water 
at 65° F. lowered the bodily heat three degrees in thirty minutes. 
The use of colder water than this (52° F.) resulted in death in twelve 
hours, and the post-mortem showed intense congestion of the colon, 
which contained bloody mucus. 

The use of water of too high a temperature is also dangerous, lest 
it produce heat-stroke. Of course no one would use water hot enough 
to produce local harm, yet it is necessary to have just enough heat 
and no more. Martin and the author proved that the use of water 
at 115° F. caused in twenty-five minutes a rise of bodily tempera- 
ture in the axilla of nearly five clegres, and developed marked symp- 
toms of heat-dyspnoea. The temperature which it is right to employ 
we found to be 101° to 103° F. as the water entered the bowel, or 
even as high as 104° F. in the water-bag if a long tube was used, as 
under these circumstances the water is rapidly cooled. An interest- 
ing result of these experiments as to heat is that Avhen cold water 
was used it took four times as long to make the injection as when 
moderately warm water was employed. 

If very large injections are used, a normal saline solution of 
7 : 1000 (1 drachm to 1 pint) should be employed to avoid the abstrac- 
tion of vital salts from the intestinal wall, with consequent passage 
of water into the tissues, making them boggy, according to the law 
of osmosis. 

In regard to the effect of distention of the bowel by injection on 
the circulation and respiration, there is practically none, but the pas- 
sage of large amounts of warmed fluid directly into the closed ab- 
dominal cavity causes death rapidly. 



HEAT. 

Heat is used locally for a number of purposes in the same manner 
as is cold, and, as was stated in the article on Cold, the choice of heat 
or cold in the treatment of any acute form of inflammation depends 
almost entirely upon the wish of the patient, who generally can tell 
at once which will give him the greater comfort. 

25 



386 REMEDIAL MEASURES OTHER THAN DRUGS. 

In sprains of the ankle nothing compares to a hot foot-bath pro- 
longed for hours, the object being to decrease the pain and swelling, 
thereby regaining the use of the limb. To carry this out effectively, 
a piece of rubber tubing of small size should be led from a wooden 
bucket, which, being a bad conductor of heat, prevents the water 
from being rapidly chilled, to a sink or large tub near by, when 
by starting the water by suction a continuous but very small stream 
can be made to flow from the bucket, while by means of another sim- 
ilar arrangement running either from another tub — or, better still, 
from a hot-water spigot — a small stream of hot water continually 
enters to take the place of that withdrawn by the first siphon. Under 
these circumstances a very constant temperature of the water can 
readily be maintained. The high degree of heat which can be borne 
by gradually increasing the temperature of the water in the supply- 
tube is very extraordinary, the favorable results obtained being in 
direct ratio to the height of the temperature. Between these soak- 
ings the part should be dressed with lead-water and laudanum, and 
rubbed now and then with camphor liniment containing laudanum. 

In spasmodic affections involving either striped or unstriped mus- 
cular fibre the local application of heat is a very useful means of 
relief. Sometimes in lumbago or muscular stiffness in other parts of 
the body the use of an ordinary laundry iron over the affected part 
will prove of great service, the skin being covered by several layers 
of newspaper to afford a smooth surface over which to pass the iron 
and to protect the parts from too great heat. 

In chordee the best means for rapid relief, other than the use of 
drugs or general relaxants, such as amyl nitrate, is to steep the penis 
in hot water. A hot sitz-bath before going to bed is a good prophy- 
lactic against this painful complication of gonorrhoea. 

In croup of the spasmodic type the local application of a hot com- 
press, made by wetting spongiopiline with hot water, is very useful, 
or, if spongiopiline cannot be had, several layers of flannel should be 
wetted, placed on the neck, and covered with cotton and oil-silk so as 
to prevent the roll from becoming chilled. 

Where attacks of dysmenorrhoea depend upon spasmodic closure 
of the cervix, with simultaneous spasm of the fundus uteri, a hot sitz- 
bath or vaginal injection is useful, and this treatment is also of value 
where uterine congestion results in leucorrhoea or a sensation of 
weight in the pelvis. Sometimes attacks of torticollis may be sub- 
dued by applying hot compresses to the sterno-mastoid muscle. 

In universal or partial spasm of the body, as well as that repre- 
sented by chorea, a hot pack is of great service, and it is to be used 
in the following manner : The child, having first been stripped of all 
clothing, is placed upon a bed which is covered by a rubber blanket, 
and immediately wrapped in a woollen blanket which has been dipped 
in hot water and the excess of water wrung out of it. Over this wet 
blanket is immediately wrapped a dry one, to retain the heat, and 
very soon the patient begins to perspire freely. Care should of course 
be taken that the temperature of the patient does not rise too high 
before sweating comes on. This hot pack will sometimes quiet a case 



HEAT. 387 

of chorea which has resisted all forms of treatment so far as drugs 
are concerned. Cases of insomnia are often benefited by a similar 
expedient, and mild cases of sleeplessness will occasionally rest 
quietly after an ordinary hot bath. 

A wet pack which speedily becomes a warm one is used in cases 
where, during the course of an eruptive fever, the eruption fades and 
it is desired to bring it out on the surface. It is also useful in those 
cases of severe chorea in which the child can stand the first shock of 
the cold. It consists in wrapping the child in a cold wet sheet and 
over this wrapping one or two blankets. In a few minutes the sheet 
becomes heated from the body, and the sweating which results is 
profuse. 

Cold should be applied to the head to relieve cerebral hyperemia 
and to prevent overheating during this treatment. 

The use of heat in tivo forms has been and is largely used at 
present for medicinal purposes, when the skin or kidneys are torpid, 
to aid in the elimination of impure and effete materials from the 
blood and tissues. These two forms of heat, the dry and the moist, 
are commonly called the Turkish and Russian baths respectively, and 
may be taken under home arrangements or in one of the establish- 
ments found in all large cities. 

The first of these is in the form of dry heat, the second is moist 
heat. The Turkish bath consists of a series of rooms ranging in tem- 
perature from 100° F. to 150° F. or more, into which the individual 
passes successively until the hottest room is reached. In each cham- 
ber he lingers until the system becomes accustomed to the high tem- 
perature, and perspiration is well established before he enters the 
hottest room, where he remains for a varying length of time accord- 
ing to the advice of his physician or his own whim or comfort. The 
rule governing his stay is that he must leave it at once if any sense 
of oppression is experienced or if perspiration does not flow freely. 
Sometimes a glass of cold water taken at this time causes a sudden 
profuse sweat, and also relieves any overheating by abstracting many 
units of heat. The cold water in the centre of the body causes con- 
traction of the blood-vessels in these parts, and the blood, rushing to 
the surface, causes the sweat-glands to pour out their secretion. 

Following the stay in the warm room, the individual passes into 
still another chamber, where he is shampooed from head to foot, well 
rubbed, and the blood made to circulate through the skin. The 
shower-bath is then used, at first hot or warm, and finally changed to 
a dash of cold, or, better still, the patient plunges into a long tank, 
swims to the other end, and is there met by an attendant who rapidly 
dries his skin, wraps a cover round him, and shows him to a lounge, 
where he is supposed to recline and sleep for an hour or less. The 
air of this sleeping-room is at the ordinary temperature of a living- 
room. 

Reviewing for a moment the effects of this bath, we find that the 
first two-thirds are devoted to the opening and stimulation of the 
pores of the skin, while the last third is devoted to the contraction 
of these pores and their supplying blood-vessels. In other words, it 



388 REMEDIAL MEASURES OTHER THAN DRUGS. 

is necessary to use the cold to prevent gradual chilling of limited 
areas, which would result in internal congestion. If the patient 
receives a cold douche, the natural rebound prevents congestion of a 
permanent nature, whereas if he is exposed to cold a long time, these 
stagnated areas become permanently diseased. The physician must 
always remember that this cold douche or plunge is a sine qua non> 
and that a rest after the bath before dressing is almost equally 
important. If the patient is too weak to bear the cold, he must not 
use the bath. 

The indication for the Turkish bath as a medicinal measure is any 
condition of the emunctories of the body whereby effete matters are 
not properly eliminated, as in Bright's disease in its various forms. 
The increased action of the skin not only casts off impurities for the 
time being, but frequent repetition of the bath causes functional 
hypertrophy of the sweat-glands, and eventually enables them to do 
more work, or, in other words, to cast off an increased quantity of 
effete material. As a consequence of this the patient is able to avoid 
uraemia or other evidences of Bright's disease, and, employing the 
normal epithelium still left in the kidney for constant use, uses the 
bath once, twice, or thrice a week with the object of abstracting the 
excess of impurities which the impaired kidneys cannot remove. 
The frequency of the bath depends, therefore, upon the rapidity 
with which the effete materials accumulate. In a case of Bright's 
disease the patient should not attempt to use the room containing 
high heat at first, and should be accompanied by a medical attendant 
to watch for untoward effects, particularly if the heart is diseased 
or uraemia is already shown by headache or other signs. If sweat- 
ing does not come on at once, danger is at hand from acute uraemia, 
renal and cerebral congestion, or heat-stroke. 

Not only is the Turkish bath useful for kidney disease, but it is 
often of great service in rheumatism. The acute form of rheumatism 
is rarely so treated, because cardiac complications often forbid expo- 
sure to heat, and fever is generally present. In subacute and chronic 
rheumatism the case is different, and the enlarged joints or inflamed 
muscles yield like magic in some instances to such treatment. Fur- 
ther than this, the muscular stiffness following prolonged or severe 
effort can be so avoided, and neuralgia depending upon rheumatic or 
gouty taint may be relieved by the hot-air bath. 

Acute colds affecting the head or elsewhere, if taken at an early 
formative stage, can often be aborted by a good Turkish bath, and 
when further developed are often greatly relieved by the same means. 
If, however, congestion of the lung, pneumonia, or chronic bronchitis, 
with emphysema or a dilated weak heart, are present, the bath may 
be dangerous. In acute pharyngitis, in which the pharynx feels like 
a raw surface or "as if it were filed or scraped," the bath will give 
relief in many instances. 

Sometimes in suppression of menstruation from cold the flow may 
be restored by a Turkish bath. 

Some persons complain that they are always catching cold upon 
the slightest provocation and apparently without cause. One class 



HEAT. 389 

seem to have delicate mucous membranes readily susceptible to irri- 
tation and inflammation ; the other have dilated or relaxed peripheral 
capillaries, which readily allow the blood in them to become chilled, 
and the individual consequently suffers from internal local congestions. 
Two separate means of treating such cases exist. The first set will 
do well on minute doses of arsenous acid (grain y^ to -^) three times 
a day, used for weeks ; the second will be cured of their habit by 
the use of a Turkish bath twice or thrice a week, since by this means 
the peripheral capillaries are toned up and made more active. 

The Turkish bath, as thoroughly carried out in large cities, is not 
obtainable for those living elsewhere, so it is well to describe a home 
modification which, with attention to detail and care, may prove 
almost, if not quite, as effective a remedy. 

The patient is placed upon a chair, naked, and under the chair 
a small alcohol lamp is put, w T hich is lighted. The individual is now 
wrapped thoroughly, chair and all, with one or two large blankets, 
and the heat of the lamp soon causes profuse sweating. Many cases 
are, however, on record where the lamp has been upset and the 
patient badly burned. The best way is to have the lamp a little 
to one side and its flame immediately under the mouth of an inverted 
funnel attached to a piece of tin tubing, the free end of which is 
placed under the blanket, so that the hot air and vapor may surround 
the body. If the tube be covered with cloth, the loss of heat is 
slight and the danger of burning the patient is removed. If this is 
not practicable, several very hot bricks or stones, thoroughly heated 
in an oven, may be placed under the chair, or small heated logs may 
be substituted. When the patient is too feeble to leave the bed, then 
it is wise to place an alcohol lamp at the foot of the couch, with an 
inverted funnel attached to a tube which passes under the bed-clothes 
in such a way as not to bring the hot air directly against the skin of 
the patient. The bed-clothing may be slightly raised to allow the 
hot air to enter. This is a valuable mode of using external heat in 
cases of shock. The vapor of the alcohol lamp tends to sweat the 
patient. 

The Russian bath differs from the Turkish in that the heat used 
is moist, not dry. As a consequence the danger of heat-stroke and 
similar states is much increased, because evaporation from the skin 
does not go on so rapidly and the body is not cooled so well in con- 
sequence. In its place the patient may be given a warm pack, which 
consists in wrapping him in a sheet and surrounding him with large 
blankets wrung out of water as hot as can be borne, which are in turn 
covered with a dry blanket to prevent cooling. (See page 386.) 

This method of treatment is useful in the same states as is the 
Turkish bath, but is more rarely used. The warm pack just named 
is also employed to develop the rash of any of the exanthematous 
fevers when it is suppressed by cold or is not " well out " on the skin. 
The temperature of the patient must be w T atched, lest he fails to have 
sweating and develops heat-stroke in consequence. A thermometer 
should be kept constantly under the tongue during the use of the 
pack, 



390 REMEDIAL MEASURES OTHER THAN DRUGS. 

The hot moist bath can also be obtained by placing a patient on 
a wicker chair under which is placed a bucket of hot water. The 
patient is surrounded by a blanket, and a hot iron or stone is put 
into the water, causing the development of a great amount of steam. 

A valuable method for using moist heat in a mild form is the 
"bronchitis tent." (See article on Bronchitis.) 

Whenever the Russian bath is used, except in the exanthematous 
fevers, it should be followed by a cold douche. 

Although these baths have been used in the treatment of cases of 
heart disease to relieve dropsy and renal engorgement, they are not 
safe and should not be generally employed. All acute or chronic 
diseases of the lung, except acute bronchitis of a mild form, contra- 
indicate their use. 

Kalashnikoff has made a series of observations on the therapeutic 
effects of heat on syphilis, and especially on syphilitic eruptions, his 
patients being inmates of the St. Petersburg Lock Hospital for Women 
and Children. The heat was applied, where possible, by means of 
partial hot-air baths to the affected part for half an hour twice a 
day, the diseased area being enveloped in hot flannel immediately 
afterward, and remaining so protected until the next hot-air bath. 
The temperature never exceeded 116° F. (46.6° C). When the 
eruption was on the back or neck or on some part which could 
not be inserted in a hot-air chamber, India-rubber hot-water bottles 
or tubes, through which hot water was kept flowing, were employed. 
When both arms or legs were affected in a symmetrical manner, 
the treatment was confined to one side, the other being left untreated 
for the purpose of comparison. The results showed that the heat 
treatment acted very energetically and beneficially on syphilides, 
both when employed alone instead of mercurials and iodides, and 
also when used in conjunction with these remedies. Often heat 
proved beneficial when the ordinary specifics had failed. Among 
other observations it was noted that hard chancres healed and the 
induration disappeared in from eight to sixteen days ; roseola and 
papular erythema disappeared in from four to eight days ; various 
forms of papular and impetiginous syphilides, with marked pigmenta- 
tion, disappeared in from eight to twenty-one days ; non-ulcerated 
tubercles and gummata disappeared in from seven to twenty-four days, 
but those which had already begun to ulcerate required from one to 
six weeks ; periostitis was cured in from ten to twenty-four days ; 
ostoses were not affected ; syphilitic ulcers, consequent on the break- 
ing down of gummatous periostitis, required treatment of from six 
weeks to three months or more, while necrosis of bone frequently 
required many months' treatment before the sequestra could be got 
away. 

HYPODERMOCLYSIS. 

Hypodermoclysis is a method of supplying fluid to the body to 
replace that lost through excessive purging as in cholera, or in cases 
of hemorrhage. Further, it may be used to wash from the body 
various impurities circulating in the blood or other liquids and to 



INTRAVENOUS INJECTION. 391 

flush out the kidneys. It consists in the introduction into the subcu- 
taneous tissues of normal saline solution, which is rapidly absorbed by 
the vessels. As is well known, a quantity of liquid equal to four times 
that of the normal amount may be passed directly into the veins with- 
out producing a rise of blood-pressure, and experiment has shown that 
within fifteen minutes after the fluid flows into the subcutaneous tissues 
an increased flow from the kidneys takes place. It is not safe to infuse 
a greater quantity of liquid than 1 drachm to each pound of body- 
weight in each fifteen minutes, as, if this amount is exceeded, the 
accumulation of the liquid in the system is so great that the tissues 
become bathed and finally drowned, because the kidneys cannot excrete 
the liquid fast enough. In the best article on this subject yet published 
in this country, Hildebrand of San Francisco carefully indicates the 
limits to which the method may be carried, and shows that if the pro- 
portions already named be preserved, the operation of hypodermoclysis 
of normal saline solution may be prolonged indefinitely, and that as 
the process goes on the urine becomes paler and is lowered in specific 
gravity until it is practically identical with the inflowing stream. To 
carry out the operation the sterilized liquid to be infused — namely, 7 
parts of sodium chloride to 1000 parts of water (3J grains to the 
ounce) — is placed in a glass jar which is absolutely aseptic, and to which 
the air only gains access by means of a glass tube filled with sterilized 
cotton. From the lower part of the vessel leads a tube to which is 
attached a trocar also rendered absolutely sterile. The skin over the 
place where the liquid is to enter is to be rendered absolutely sterile, 
and the trocar is then inserted into the subcutaneous tissues of the 
thighs, or, preferably, of the abdomen, and the liquid allowed to flow 
at the rate named, the pressure being obtained by raising the con- 
tainer two or three feet above the belly-wall. As the liquid enters a 
swelling appears in the subcutaneous tissues, which soon disappears 
after the infusion ceases, and is much aided in its absorption by 
the use of massage. 

When hypodermoclysis is employed after hemorrhage the results 
are often extraordinary, and Cantani, who has used the method to 
overcome the drying of the tissues in cholera, praises it most highly, 
as does also his critic, Oser. The cyanosis decreases rapidly, the 
pulse improves wonderfully, and the respirations are no longer dif- 
ficult. Sahli of Berne has used hypodermoclysis with very good 
results in the treatment of uraemia, and he thinks that not only are 
the poisons washed out of the system by this method, but in addition 
that the dilution of the poisons prevents them from acting so forcibly. 
In septicaemia, diabetic coma, and similar states this method of treat- 
ment should be employed and results carefully recorded and reported. 

In cases of surgical shock warm saline fluid used by hypoder- 
moclysis is often of great service. 

INTRAVENOUS INJECTION. 

Intravenous injection is a method which is to be employed only 
under extraordinary circumstances and with only a few drugs. Thus 



392 REMEDIAL MEASURES OTHER THAN DRUGS. 

in the case of snake-bite it may be advisable to resort to such an 
Injection of diluted aqua ammonia or ether, or even warm brandy or 
whiskey. Under these circumstances the injection should be made 
into a vein in the leg, rather than one in the arm, as the drug under 
these circumstances does not reach the heart in so concentrated a 
form and cardiac depression is thereby avoided. 

The objections to intravenous injections are several. In the first 
place, the veins are apt to be collapsed and hard to find, and it is still 
more difficult to puncture one without wounding the opposite wall of 
the vessel. Again, phlebitis is a very probable sequel, and thrombosis 
and embolism are by no means impossible. 

It is needless to say that the solution which is injected into a vein 
should always be of a neutral or alkaline reaction in order to avoid 
coagulation of the blood. (See Transfusion.) 



KATAPHORESIS. 

By the term u kataphoresis " we mean a method resorted to by 
physicians having for its purpose the introduction into the body of 
drugs through the influence of electricity. Correctly speaking, kata- 
phoresis is an osmosis of medicaments through the tissues, the 
osmosis being carried on by the galvanic current and the drug being 
carried through the tissues between the two poles. Quinine, iodide 
of potassium, the various soluble salts of mercury, and chloroform 
and ether may be so used. The ordinary sponges or absorbent cotton 
tips of the electrodes may be saturated with the medicament to be 
used, and the constant current employed, the current being reversed 
every few minutes. The positive pole of the battery is placed over 
the affected part, and the negative at a little distance away. 

In cases of neuralgia, chloroform and alcohol, of each one-half, or 
•even pure chloroform, may be employed, and in syphilitic nodules, 
when the patient's stomach cannot bear drugs, kataphoresis with 
iodides over the part affected may be resorted to. The iodide of 
lithium is commonly employed in the strength of 5 per cent, in these 
cases. The strength of the current depends upon the size of the 
electrodes and the sensations of the patient. It is not necessary to 
use a stronger current than the patient can bear with comfort. 



LAVAGE. 

This is a term applied to washing out of the stomach in cases of 
gastric dilatation, fermentative dyspepsia, and more rarely in cases 
of gastric carcinoma. It is particularly valuable in the two first- 
named conditions, not merely for its curative power, but also to rid 
the stomach of mucus and render it clean before fresh food is placed 
in it. 

Originally proposed by Epotius in 1863, it has been most widely 
employed in children by Epstein, who in one article alone records its 






LAVAGE. 393 

employment in 286 cases of gastric disease in infancy, the patients 
being less than one year of age. 

Epstein employs a No. 8 or a No. 10 Nelaton catheter for the tube, 
and warm water holding in solution a little benzoate of magnesium or 
boric acid, the latter being resorted to chiefly when fermentation- and 
decomposition-products are present. If none of these conditions are 
present, ordinary water will usually suffice. The liquid employed 
should always be warmed. Others — as, for example, Lorez — use the 
ordinary catheter, of the size known as No. 13 or No. 15, in children, 
but for an adult a tube should be used of at least four and a half to 
five feet, of which eighteen inches pass into the mouth, the remain- 
ing portion reaching to the basin when lowered to allow siphonage. 
The question as to the variety of tube to be employed is a vital 
one, since a poorly-devised apparatus not only gives no relief, but 
disgusts both the patient and the physician with the technique of the 
method. The tube should be more like a hollow bougie than a cathe- 
ter, in order that its calibre may be great enough to carry off some 
of the semi-solid materials present. If this rule is not carried out, 
two evil results follow : In the first place, the tube and its apertures 
rapidly, or even at once, become clogged; secondly, the liquid is 
drained away, leaving behind a mass which is semi-solid, to be sure, 
and less bulky, but which is nevertheless the quintessence of the 
nastiness of fermentation, and quite as qualified to leaven any fresh 
food on its entrance as the liquid would be. 

The holes in the gastric end of the tube should therefore be large 
enough to take in fairly large masses. In some cases the ordinary 
siphon may be used, but where there is any solid food or resistance 
suction by means of a stomach-pump is necessary- The best tube 
is one of red Para rubber with a closed end and lateral holes, No 10. 

The methods by which lavage is employed, further than those 
we have named, are as follows : The tube should be passed back- 
ward against the roof of the mouth, so that by following the curve 
of the hard and soft palates it is directed into the pharynx and 
oesophagus, and then by gentle pressure forced on down into the 
stomach. At the same time the patient should be directed to swallow. 
The mucus in the throat sufficiently lubricates the tube, and oil is to 
be avoided. If gagging is excessive, the pharynx may be first painted 
with cocaine. The irritability of the pharynx usually rapidly disap- 
pears, and it is surprising how quickly the patient may become accus- 
tomed to the operation, and submit to it without any feeling of dis- 
comfort. After the tube has reached the stomach a small funnel is 
to be fitted in its external end, which is then held above the head of 
the patient while water prepared in the way we have mentioned is 
poured into it until the stomach is filled, when the funnel end is low- 
ered and the stomach is emptied by siphonage. 

The stomach-pump has one very serious disadvantage, which is 
present with even more force in the case of a child than in an adult — 
namely, the danger of injury to the coats of the organ. This appa- 
ratus is also more costly and cumbersome, and for children the siphon 
is powerful enough in its action to take away all excuse for the use 



394 REMEDIAL MEASURES OTHER THAN DRUGS. 

of the more complicated apparatus unless the contents of the stomach 
are in bulk. 

It is particularly necessary in children, if a catheter is used and 
on account of the lack of intelligent aid and their liability to gulp, 
that every care should be taken that the tube does not slip entirely 
out of reach into the stomach ; and for the prevention of this danger 
a string should be attached to the external end of the catheter before 
it is introduced, and the tube should always be at least thirty inches 
in length. 

LEECHING. 

Leeching is a method of abstracting blood for the purpose of 
relieving local inflammations or acute congestions. There are two 
forms of leech commonly employed in medicine, both of which are 
imported. A small leech is found in many streams in the United 
States. Leeches, after attaching themselves to the skin by means of 
their sucking apparatus and teeth, secrete a liquid which prevents 
coagulation of blood, and this accounts for the persistent hemorrhage 
sometimes seen after a leech-bite. 

Therapeutics. — The reasons for using venesection or depletion have 
already been considered, and we can therefore pass directly to the 
uses to which leeches are put. In cases of meningitis they may be 
applied to the temples or to the nape of the neck, and in the treat- 
ment of swollen joints, such as occur after sprains, they are useful. 
In orchitis they should not be placed upon the scrotum, but on the 
perineum. In conjunctivitis or inflammation of the eye they should 
be applied upon the temple or back of the ears, not upon the lid 
itself. 

Employment. — Leeches if singly applied may be placed on the skin 
under an inverted wineglass or under a large pill-box. If they will 
not take hold, a little sweetened milk may be placed on the skin or a 
drop of blood extracted from the finger may be placed there. In all 
cases the skin should be carefully washed before the leech is used. 
When the leech has taken enough blood, it can be made to let go its 
hold by sprinkling it with salt. Each leech will take about 1 drachm 
of blood. Leech-bites should be watched lest prolonged consecutive 
bleeding exhaust the patient. In case of such an accident styptics 
are to be employed. As leech-bites make permanent scars, the ani- 
mal should not be applied on the face or other exposed surface. 



REST CURE. 

The rest cure, so called, is a method devised and elaborated by Dr. 
S. Weir Mitchell of Philadelphia for the relief of a large class of 
patients who, for various reasons, are generally ailing from apparently 
no organic disease, and yet whose condition is often so alarming as to 
lead to the belief that some hidden cause of a severe train of symp- 
toms must be present. In many such instances a careful study of 



REST CURE. 395 

the case will show that there is a cause, near or remote, which has 
exhausted the patient's vital forces without producing anything else 
than functional disturbances of the body. Thus a prolonged nerve- 
strain in nursing a sick relative may so exhaust the strength of a 
hitherto healthy woman as to produce hysteria, anaemia, and great 
disturbances of nutrition, or, in another instance, cause neuralgia, 
disordered menstruation, and uterine or ovarian pain. In males 
mental, sexual, or physical vigor may be impaired, owing to pro- 
longed anxiety in business. Be the symptoms what they may, as 
long as they are dependent upon nerve-strain this "cure" is to be 
resorted to, and if properly carried out is often blessed with surpris- 
ing results. Before describing the method in detail it is proper to 
state that its entire rationale rests upon the remembrance that every 
movement is an expenditure of force, and that a system which has 
already overdrawn its reserve fund of strength must be as careful 
with its funds that remain as a bank should be under the same cir- 
cumstances. 

It having been decided that the rest cure is to be employed, the 
directions are given as follows : 

A bright, airy, easily-cleaned, and comfortable room is to be 
selected, and adjoining it, if possible, should be a smaller one for an 
attendant or nurse. The patient is put to bed and kept there for 
from three to six weeks, as may be necessary, and during this time is 
allowed to see no one except the nurse and the doctor, since the pres- 
ence of friends requires conversation and mental effort. The patient, 
in severe cases, must be fed by the nurse, in order to avoid the expend- 
iture of the force required in the movements of the arms. No sitting 
up in bed is allowed, and if any reading is done it must be done by 
the nurse, who can read aloud for an hour a day. 

In the case of women the hair should be dressed by the nurse to 
avoid any physical effort on the part of the patient. 

To take the place of ordinary exercise two measures are employed, 
the first of which is massage or rubbing of the body, the second elec- 
tricity. By the kneading and rubbing of the muscles and skin the 
liquids in the tissues are absorbed and poured into the lymph-spaces 
and a healthy blush is brought to the skin. This passive exercise is 
performed in the morning or afternoon, and should last for from a 
half to one hour, every part of the body being kneaded, even to the 
face and scalp. In the afternoon or morning the various muscles 
should be passively exercised by electricity, each muscle being made 
to contract by the application of the poles of the battery to its motor 
points. Both these forms of exercise do not call for any expenditure 
of nerve-force, though they keep up the general nutrition. The fol- 
lowing programme for a day's existence is an example of what the 
physician should order : 

7.30 a. M. Glass of hot or cold milk, predigested, boiled, or raw 
as the case requires. 

8 a. M. The nurse is to sponge the patient with tepid water or 
with cold and hot water alternately, to stimulate the skin and circu- 
lation, the body being well wrapped in a blanket, except the leg or 



396 REMEDIAL MEASURES OTHER THAN DRUGS. 

portion which is being bathed. After this the nurse should dry the 
part last wetted with a rough towel, using some friction to stimulate 
the skin. 

8.30 a. M. Breakfast. Boiled, poached, or scrambled eggs, milk 
toast, water toast, or a finely-cut piece of a mutton-chop or chicken. 

10 a. M. Massage. 

11 A. M. A glass of milk, or a milk-punch, or egg-nog. 

12 M. Reading for an hour. 

1 P. m. Dinner. Small piece of steak, rare roast beef, consomme 
soup, mutton broth, and any one of the easily-digested vegetables 
well cooked. 

3 p. m. Electricity. 

4.30 p. M. A glass of milk, or milk-punch, or egg-nog. 

6.30 p. m. Supper. This should be very plain, no tea or coffee, but 
toast and butter, milk, curds and whey, or a plain custard. 

9.30 p. m. A glass of milk or milk-punch. 

In this way the day is well filled, and the time does not drag so 
heavily as would be thought. If the stomach rebels at over-feeding, 
the amounts of food must be cut down, but when all the effort of the 
body is concentrated on respiration, circulation, and digestion a large 
amount of nourishment can be assimilated by the exhausted body, 
which before this treatment is undertaken may have had its resources 
so scattered as to be unable to carry out any physiological act per- 
fectly. 

For the treatment to be successful the rules laid down should be 
rigidly followed and never remitted for a single hour. 



MINERAL SPRINGS AND CLIMATE. 

This article is intended to give the practitioner and student a gen- 
eral idea of where to send patients who can afford to resort to treat- 
ment depending upon watering-places and climates. It is manifestly 
impossible to include the names of all the health-resorts, and the 
object has been to indicate the diseases which are benefited by these 
treatments, taking certain well-known resorts as types of each class. 

Springs. 

Medicinal springs are usually resorted to for the double purpose 
of drinking and bathing in the waters, although in many instances 
one of these methods so far exceeds the other in popularity that it 
alone is employed. 

For general purposes we may divide these medicinal or beneficial 
waters into four classes — namely, those which act, first, by their 
purity chiefly ; second, by the presence of more or less active alkaline 
ingredients ; third, by the heat which the waters contain as thev 
leave the earth ; and, fourth, by reason of the sulphur and iron which 
they contain. The first class — namely, those which act by reason of 
their purity — are indicated chiefly in cases where through high living 



MINERAL SPRINGS AND CLIMATE. 397 

or other cause the system becomes laden with impurities through 
imperfect elimination of tissue-waste. Most of the popular lithia 
waters depend chiefly upon this ability to dissolve effete materials, 
and very little upon the lithia, which is often present in very small 
amount. (See Lithium.) Aside from their purity, they also act by 
reason of the salts of sodium and calcium which they contain. Good 
results follow their use in the uric-acid diathesis where the urine is 
scanty, high-colored, and acid. They do good in cases of irritable 
bladder by washing out this viscus with mild urine in large quantities, 
and because of this influence are credited with wonderful cures of 
vesical calculus. When vesical calculi have broken down while these 
waters were being taken, the fortunate result has been coincidence 
rather than medicinal interference. It is impossible for them to dis- 
solve stones, but their constant use may prevent the formation of new 
ones. Perhaps the best representative of such waters is Londonderry 
lithia water. 

A subdivision of this class consists of those waters which contain 
somewhat larger amounts of mineral substances, chiefly potassium, 
sodium, and calcium salts. Because of the power possessed by alka- 
line salts in aiding in oxidation, these waters are used in cases where 
the effete matters of the body seem to escape only partly oxidized, and 
where the kidneys, and perhaps the liver, seem torpid. Such springs 
are the Kissingen and A T ichy at Saratoga. If very mild purgative prop- 
erties are also desired, the Geyser Spring at Saratoga may be used. In 
Europe the most famous springs of this class are at Vichy (Grande 
Grille), Vals, and Contrexeville in France, and Kissingen in Bavaria. 

The second class of springs are those which contain salts of sodium, 
calcium, potassium, and magnesium in sufficient amount to possess 
very active diuretic and purgative properties. They find their thera- 
peutic application in cases of hepatic torpor or congestion associated 
with gouty or rheumatic tendencies, particularly in those individuals 
who have been high livers, who lay on too much fat, so clogging their 
organs, and, finally, in those who through illness or exposure to hot 
climates have subacute or chronic atony of the liver, of the organs 
of digestion, and of the lymphatics. Nearly always these patients 
also suffer from more or less constipation and gastrointestinal catarrh, 
and are often obese. The sulphate of sodium is an ingredient of 
many purgative mineral waters, and the activity of a water depends 
very often on the percentage of this salt w T hich is present. The pur- 
gative action of a water also depends upon the time at which it is 
taken. When taken on an empty stomach it is of course more active. 
When taken early in the morning before eating and at the natural 
temperature such a water produces a loose watery movement, not 
only unloading the bowel of fecal matter, but by its alkalinity loosen- 
ing catarrhal secretions and unloading the liver of congestion. The 
quantity to be taken in twenty-four hours varies from 1 to 4 pints, 
but this question can only be decided by the local physician, who 
studies the effect of the water on the patient. The best-knowm waters 
of this class are the Champion, Congress, Hathorn, and Carlsbad 
Springs at Saratoga, New York, the Crab Orchard in Kentucky, and 



398 REMEDIAL MEASURES OTHER THAN DRUGS. 

the springs of Carlsbad and Marienbad in Bohemia, and Friederich- 
shall in Germany. 

The hot springs depend chiefly on their heat, as already stated, 
and differ in chemical composition. They find their value in the 
treatment of chronic skin diseases, specific or otherwise, and also are 
useful in aiding in the treatment of rheumatism, gout, and syphilis. 
Their good results are produced by their heat, which varies from 
93° F. to 150° F., and the advantages always derived from properly 
employed hydrotherapeutic measures. It is in chronic or subacute 
cases that they do the most good. Hot baths are also of great value 
in the treatment of chancroid and malignant syphilis. The results 
achieved depend upon the increased activity of the skin, the improve- 
ment of the peripheral circulation, and the increased powers of absorp- 
tion produced through increased cellular activity. 

Patients should always select a competent local physician at such 
places. 

In cases of syphilis the methods to be followed are as follows: The 
patient should take the bath at a temperature of 90° F., and remain 
in it for about twenty minutes. After this he is rapidly but thor- 
oughly dried by an attendant, who at once proceeds to rub into the 
skin of one thigh an amount of mercurial ointment varying from a 
few grains to a drachm. This is well rubbed into, not smeared over 
the skin, a different limb after each bath. The number of baths and 
inunctions depends upon the condition and necessities of the case, 
care being exercised not to push the mercury too freely in those who 
are very susceptible to its use. These baths also aid in the absorp- 
tion of mercury when it is administered by means of fumigation. 

The most celebrated of these springs are the Hot Springs of 
Arkansas and those found at Aix-la-Chapelle in France. 

As types of the fourth class of springs we have the White Sulphur 
Springs in West Virginia and the Richfield Springs in New York, 
which are used for the relief of catarrhal inflammations of the mucous 
membranes of the alimentary canal and respiratory passages, and 
more rarely for catarrhal states of the genito-urinary tract. Not 
only do they exert the peculiar remedial powers long known to belong 
to sulphur and its compounds by reason of the sulphuretted hydrogen 
gas contained in them, but they also possess distinct purgative effects. 
Their chief mineral constituents consist of sulphate of sodium and 
magnesium, which unload the bowels and portal system in the same 
manner as do the Champion, Congress, Hathorn, and Carlsbad 
Springs at Saratoga and those at Crab Orchard. Taking the White 
Sulphur as a type of its class, it is better than the Saratoga springs 
in catarrhal states for the reasons given. 

Rockbridge Alum Spring in Virginia is used in cases of chronic 
diarrhoea with very useful results in many cases. It is not so useful 
in acute inflammations of the intestine as in the diarrhoea due to 
chronic disorder. As iron is present in it and in most alum springs 
in considerable amount, this water is useful in anaemic cases, but is 
contraindicated by fevers, by chronic congestions, chiefly of the liver, 
and by plethora. Often in place of alum we find salines associated 



MINERAL SPRINGS AND CLIMATE. 399 

with the iron, and these waters are particularly indicated in the 
catarrhs associated with ansemia. Such a spring exists at Bedford, 
Pennsylvania. In Europe the chief iron springs are at St. Moritz in 
Switzerland and Tunbridge Wells in England. Neither of these 
contains much sulphur or alum. 

Climates. 

The practitioner is most frequently consulted as to the possible 
benefit of climatic changes by persons suffering from pulmonary dis- 
ease, such as tuberculosis of the lungs, asthma, chronic bronchitis, 
and emphysema — more rarely by those convalescing from pneumonia 
or other severe acute illness. 

The general rules to be followed in all cases are — first, choose 
a climate having as large a number of clear days as possible, in 
order that an out-of-door life in the sunshine may be had in plenty ; 
second, the nearest place to the home which is available in order to 
avoid fatigue, expense, and home-sickness ; and third, see that the 
resort chosen has comfortable accommodations, good drug-supplies, 
and a capable physician to be called in case of need. In a case of 
tuberculosis and in all patients suffering from the pulmonary com- 
plaints named above the following rules may be adhered to, except 
in persons suffering from attacks of acute bronchitis, who always 
need a climate providing moisture and warmth. Some tubercular 
patients do best in a high, dry air, and others in a lower and more 
moist temperature — the first being represented by that of Colorado 
Springs (6000 feet) in America and by San Moritz (6000 feet) and 
Davos Platz (5000 feet) in Switzerland, where the altitude is not 
only very great, but the air very cold in winter. The days in these 
places are many of them clear, but apt to be windy. Feeble persons 
cannot stand high winds, as a rule. The second climate is repre- 
sented by that of Florida. 

In the majority of cases, however, some more moderate climate 
is useful, and this can be obtained in Lower California, as at San 
Diego, a place where there is virtually perpetual summer, or at 
Asheville, N. C. (2200 feet), or Thomasville, Georgia (330 feet), 
where the air is moderately dry and the climate not subject to 
sudden changes of temperature or to frequent storms. In other 
words, a spot is desirable where a patient can remain the year 
round, and, if well enough, engage in business, avoiding the cold, 
sharp March winds of the Middle, Eastern, or North-western States, 
and the necessity of leaving Florida on the advent of summer. 

Physicians have attempted for years to formulate rules for phthis- 
ical patients as to the climate to be sought. In very many cases 
the various health-resorts have to be chosen by experiment, not by 
judgment beforehand. In cases of phthisis with profuse bronchial 
secretion a high, dry climate is generally the better, but in cases 
which suffer from dryness of the air-passages a sea-voyage or a warm 
moist climate is better, on general principles. It is probably true, 
however, that high altitudes and rarefied air are not to be sought 



400 REMEDIAL MEASURES OTHER THAN DRUGS. 

where a distinct tendency to hemorrhage is present, unless the ascent 
or removal to the rarefied air is very gradual, several weeks being 
passed before the lung is exposed to the low pressure of great 
heights. The cases in which high altitudes do good are those which 
have poor thoracic development or chronic pleurisy with deficient 
expansion of the lung after tapping. The following excellent advice, 
given by White in his General Therapeutics, is worthy of repetition : 

"It is of such importance that only suitable cases should be sent 
to high altitudes that we must point out those that are unsuitable : 

" 1. Those in whom there is considerable affection of the bronchial 
tubes, for the dryness of the climate increases the kind of bronchitis 
which commonly accompanies phthisis. 

" 2. Patients with much emphysema or bronchiectasis, because of 
the probably diminished absorption of oxygen and the difficulty of 
respiration experienced on first arriving. 

" 3. Patients with disease of the heart must not go to a high alti- 
tude, because of its effect upon the pulse and upon respiration. 

" 4. Cases liable to acute febrile attacks, whether or not these 
indicate an occasional increase of mischief in the lungs, should 
remain on a low level. 

"5. Patients who are very excitable or suffer from insomnia 
should not go, for a visit to a place at a great elevation promotes 
these symptoms. Women do not acclimatize so well as men. 

" 6. Cases in which there are very extensive lesions, or which are 
very advanced, are unsuitable. 

" Pneumonic phthisis, if at all acute, is made worse by a high 
altitude. 

" 8. Patients who cannot take exercise should not go. 

" 9. The very old and the very young had better be treated at 
home. 

" 10. Sir Andrew Clark (London Lancet, January 5, 1889) states 
that patients who go to Alpine health-resorts suffering from albumin- 
uria, or those who develop it whilst there, seldom derive any good 
from their change. 

"There are many conditions which have been thought to contra- 
indicate this treatment, but which do not, and they had therefore 
better be mentioned. They are — 

"Pulmonary Hemorrhage. — It is now known that this, so 
far from being a contraindication to treatment by high altitudes, is 
actually relieved by it. The exact explanation cannot be given." 

With this the author of this book cannot agree. 

"Fever. — If this is not excessive, and if it does not indicate any 
active changes in the lungs, it is often improved. 

" Simple Diarrhoea and Simple Dyspepsia. — These are both 
benefited. 

"Night-sweats. — There is a common belief that these forbid this 
treatment ; on the contrary, they often disappear on removal to a high 
altitude. 

" The Presence of Cavities. — This is not a contraindication, 
unless a very large area of lung is destroyed. 



SUSPENSION. 401 

" There is no need, after these two lists, to say what cases are suit- 
able for this climatic treatment : it may, however, be observed that 
those in which there is threatened phthisis, with a strong hereditary 
predisposition, and those of imperfect thoracic development, are much 
benefited. According to most authorities, it cannot be too strongly 
urged that so long as the condition and disease of the patient allow 
the reverse indications to be neglected a mountain climate should be 
tried." 

To these rules the author would add the following invariable rule : 
viz. Do not send a case away to die. If the disease is so far advanced 
that no good can be derived from a trip abroad, it is cruel to make a 
wretched patient exhaust his strength, his money, and his happiness 
by seeking health which it is impossible for him to obtain. A patient 
of the writer's returned on one occasion from a stay of a few days at 
a noted Southern resort for consumptives, who, when reprimanded for 
his imprudence, replied : " Doctor, I would rather be at home, and 
die at once, than drag out a few more years surrounded by a crowd 
of coughing, hawking, and wasting consumptives." This reply evi- 
dences clearly the necessity of avoiding " consumptive resorts " as 
much as possible in these cases, and in directing the mind of the 
patient from depressing thoughts and his own ailment. 

In the treatment of renal and cardiac disease high altitudes are 
not particularly desirable. The chief desideratum is out-of-door life, 
with avoidance of chilling of the skin by sudden changes in tempera- 
ture or strong winds. San Diego represents the necessary climate in 
such cases. 

There is a class of persons who often have no actual disease of a 
chronic type, who nevertheless pass healthier lives if away from rig- 
orous climates for at least part of the year. Without having acquired 
tuberculosis, their lungs are delicate naturally or because of attacks 
of disease^ or, again, they become asthmatic or rheumatic in cold 
weather. In this country Asheville, N. C, and Thomasville, Ga., or 
San Diego or Coronaclo Beach, California, afford the climate desired, 
while in Europe patients are sent to what is known as the " Riviera," 
which is the district bordering on the Mediterranean Sea from Genoa 
to Nice and which is dotted with climatic resorts. This district has 
often as many as two hundred clear days between October 1st and 
May 1st. In the French Riviera the resorts are Cannes, Nice, 
Monaco, Monte Carlo, and Mentone ; in the Italian Riviera, Bordi- 
ghera and San Remo. In Naples and Spezzia the climate is more 
damp and colder, but nevertheless quite sunny. So much depends 
upon the location of the hotels in these places, as far as their salubrity 
in relation to air and dampness is concerned, that the patient should 
always consult a local physician before settling down permanently at 
any of these resorts, 

SUSPENSION. 

The treatment of locomotor ataxia and allied affections by means 
of suspending the patient has, during the last few years, been found 

26 



402 REMEDIAL MEASURES OTHER THAN DRUGS. 

so valuable for the relief of symptoms as to have taken a permanent 
place in therapeutics. The method is not confined to cases depend- 
ing upon diseases of the vertebrae producing lesions in the spinal cord, 
but is equally useful in instances where the lesion is primarily situated 
in the nervous centres. The pain, nervous shootings, and tinglings, 
as well as the muscular contractions, which often trouble the patient 
very greatly, are all relieved, and in some cases walking is possible 
where, before the treatment, crutches were entirely relied upon. The 
knee-jerk, when absent or excessive, tends to return to the normal 
state, and the bladder and rectum become more regular in their 
functions. 

The patient should use one of the apparatuses made by most large 
surgical-instrument makers, which consists in a cushioned head-strap 
and a cushioned leather loop for each axilla. The traction on the 
head should not be sufficient to cause discomfort ; in other words, the 
weight of the patient should be equally distributed between the shoul- 
ders and the head. A rope is run from the harness to a pulley in the 
ceiling, and by this means the patient may be slightly raised from his 
chair — say two inches — once a day, for thirty seconds at first, which 
may gradually be increased to ten minutes. The swinging should be 
resorted to at first every second and third, and finally every, day. If 
several pulleys are put in the circuit of rope, the patient can soon 
learn to lift himself, making the rope fast to a cleat in a heavy chair 
or table, or even holding it in the hands. It is important that the 
patient after each swinging should rest for thirty minutes to an hour, 
and when let down to his chair the movement should be most gentle 
and not jerking or sudden. The same rule as to gentleness applies 
to raising the patient. 



TRANSFUSION. 

Very closely allied to the intravenous injection of medicines is the 
transfusion of saline liquids, blood, or defibrinated blood for the pur- 
pose of replacing the vital fluid which may have been lost by hemor- 
rhage. It must be distinctly understood that transfusion is not to be 
resorted to in the presence of heart failure arising from other causes 
than hemorrhage, nor for the purpose of improving the state of the 
blood in the vessels. Its effect is only temporary, and it is used solely 
for the purpose of bridging the chasm until the system can manufac- 
ture normal blood after a sudden loss. It has been found that the 
transfusion of pure blood even in the " direct method," which will be 
presently described, is no better than the employment of a properly 
made saline fluid, because the corpuscles are killed by the change of 
abode, even from man to man, and their destruction gives the kidney 
the work of eliminating the free haemoglobin. 

Direct transfusion may be performed by the employment of a large 
number of complicated pieces of apparatus, but the simplest manner 
of procedure is as follows, provided a good-sized vein is used and the 
blood-donor is full-blooded, as he ought to be : An incision is made 



TRANSFUSION. 403 

in the arm of the donor over the longitudinal axis of the vein, gen- 
erally a prominent one on the flexor surface of the forearm or arm. 
As soon as the vessel has been cleanly dissected from the surrounding 
tissues, a bull-dog clip should be placed above and below the point 
where it is intended to make the incision in the vessel. At the same 
time a silk ligature is passed under the vessel. The vessel is now 
longitudinally incised, and a small glass or metal canula furnished 
with a shoulder is slipped into the opening, with its point toward the 
wrist, after which the ligature is tied so as to hold the canula in place. 
The opposite end of the canula should be attached to a short rubber 
tube of about eight inches in length, and the moment this is in place 
the canula and tube should be filled with a normal saline solution. 
(See below.) The same process is then repeated with the vein of the 
recipient, except that the canula is not armed with a rubber tube, and 
is pointed toward the body of the patient, or, in other words, in the 
direction of the blood-stream. 

The only point where great care is to be exercised is in the filling 
up of the tubes with saline solution to displace the air. 1 The tubes 
being completely filled, the ends are joined by slipping the tube of 
the recipient into the rubber tube of the donor. The bull-dog clip 
next the shoulder of the recipient is now removed, and the one next 
the hand of the donor is taken off, thus allowing the blood to flow 
from one person to the other. It is necessary that the other clips 
should remain to prevent hemorrhage by anastomosis back of the 
canulas. If the pressure is low in the vein of the donor, the passage 
of the blood from the one to the other must be aided by stroking the 
tube in the direction of the flow, using enough compression to dis- 
place the fluid. If the tubing is elastic and strong, this method is 
fully as good as that of Aveling, where it is necessary to use a ball 
syringe to propel the blood and fill the tubes. The normal saline 
liquid already named consists in a solution of common salt of the 
strength of nearly 6 parts to the 1000, or, in other words, six-tenths 
of 1 per cent. — or, in other words, 1J drachms — of pure common salt 
to a quart of distilled water. It is called a normal solution because 
its percentage of saline is exactly that of the blood. 

The amount of blood transfused may be from 2 ounces up to the 
point at which its withdrawal causes the donor to feel faint, but 8 
ounces is generally the maximum amount used. It is to be remem- 
bered that the passage of the liquid must be gradual, not sudden, and 
that an excessive amount may cause cardiac distress. 

The use of clefibrinated blood ought never to be resorted to when 
direct transfusion or a proper saline is to be had, as the difficulty in 
separating all the minute coaguli is very great, and it is also difficult 
to maintain the temperature. If direct transfusion is not wished for, 
the saline solution named may be gently forced into the vein by 
means of a good hydrostatic syringe raised very slightly above the 

1 Whether or not small amounts of air finding entrance into the veins do any harm 
is not decided. A number of deaths in man from this cause are reported, but the 
experiments of Senn and of the author show that large amounts have to be introduced 
before death occurs. As the dread of such an accident is part of the medical teaching 
of the past, it is at least well to respect it. 



404 REMEDIAL MEASURES OTHER THAN DRUGS. 

level of the patient. The water used should always be boiled and filtered 
to render it aseptic. The solution used should, of course, be warm, 
at a temperature of about 100° or 101° F., and the presence of any 
foreign or insoluble substance must be strenuously guarded against. 
Indeed, it is always best to pass the liquid through a fine sieve before 
it is used. The quantity of saline used should not exceed 1 pint, 
and this is usually more than should be given, unless the hemorrhage 
has been exceedingly severe and the patient really improved by the 
addition of each ounce of liquid. 

In a large number of cases warm fresh milk, just as it is drawn 
from the cow, has been used as an injection into a vein with success, 
but it always causes albuminuria, and is not as good as directly trans- 
fused blood, nor better than saline solutions unless it is taken directly 
from the udder of the cow as it is milked. The possibility of the cow 
being tuberculous is also to be remembered. 

Abdominal transfusion of both saline solutions and milk have been 
successfully carried out, the reason being that the peritoneal cavity is 
a vast absorbent surface which rapidly takes up liquids if the systemic 
vessels are not as fall as they normally should be. The method con- 
sists in puncturing the abdominal wall as if for aspiration for dropsy. 
The tube from a hydrostatic syringe is now attached to the canula, 
and the liquid, having been warmed, is allowed to slowly flow into 
the belly. This method is not to be relied on where death seems 
very imminent, as it is not rapid enough in its effects. 



VENESECTION. 

Bleeding, or Phlebotomy, is so rarely practised to-day that very 
many of the profession have never abstracted blood for therapeutic 
purposes or have even seen it done by some one else. Furthermore, 
it is to be feared that many of the younger physicians would hardly 
know how to bleed if called upon to do so at a crisis. All this is 
wrong, for bleeding is a measure undoubtedly of the greatest value 
and one which every one may be called upon to resort to. Like many 
therapeutic measures, it was sadly abused in the early part of this cen- 
tury, and people were bled when taken ill with the same regularity 
that they were put to bed. 

The indications for venesection are as clear and well defined as are 
the indications for any remedy. Briefly stated, we may say that all 
states of the circulatory apparatus denoting high arterial tension and 
excitement are indications, and that weakness, low arterial tension, 
and systemic or circulatory depression are contraindications. Since the 
use of veratrum viride has become more common, the conditions indi- 
cating venesection have been lost sight of, because this drug so dilates 
the blood-paths that a man is bled into his own blood-vessels. 

Having made clear the general indications for the use of venesec- 
tion, we may pass on to state some of the diseases in which it may be 
well resorted to. Of these, pneumonia, pleurisy, meningitis, and peri- 
tonitis, if they are sthenic, are typical examples, since all of them 



VENESECTION. 405 

are accompanied by arterial excitement and characterized by local 
congestions affecting the lung, pleura, cerebral membranes, or peri- 
toneum. (See Pneumonia.) By the abstraction of blood the vascular 
tension is lowered and the engorged area relieved. In the first place, 
the congested area is made up of relaxed blood-vessels, whereas the 
remaining blood-vessels of the body are tense, and, as a consequence, 
the blood is urged to the spot already engorged. In the second place, 
the abstraction of blood from the tense blood-vessels renders the gen- 
eral pressure lower than that in the diseased area, and the congestion 
is relieved. 

In apoplexy the extravasation of blood into the brain causes great 
arterial excitement, as a general rule, and this in turn results in 
increased intracranial hemorrhage. Bleeding is therefore strongly 
indicated, not only to prevent inflammation, but also to prevent further 
leakage into the brain-substance. 

The method by which venesection is practised is yet to be described. 
It is a very simple operation if an assistant is present to make pres- 
sure on the vein or entire arm. Often this pressure is best exercised 
by means of a handkerchief or bandage tightly twisted about the 
arm above the spot where the incision is to be made. Under these 
circumstances the veins of the arm become prominent and distended, 
and one of them may be readily bared by a short longitudinal incision 
of half an inch, the fascia being separated until the glistening blue 
surface of the vessel appears free from fat or connective tissue. Into 
this vessel, with the edge of the knife turned upward, a small longi- 
tudinal incision is made, care being taken that the point of the blade 
is not driven in far enough to injure the posterior wall of the vein. 
If a clot forms and stops the flow, it must be removed by an aseptic 
€loth, while if the flow is to be stopped we may remove the bandage 
above and apply a compress over the incised vein, which compress 
may be held in position by a bandage. 



FOODS FOR THE SICK. 



PEPTONIZED MILK. 



Take a perfectly clean, clear glass quart bottle and place in it the 
contents of one of Fairchild Bros.' peptonizing tubes or Parke, Davis 
& Co.'s peptonizing tablets, that containing the sodium and that 
containing the pancreatin, and a teacupful of cold water, and after 
shaking pour into the bottle a pint of perfectly fresh, cool milk and 
stir the mixture thoroughly. Next place the bottle containing the 
milk in a can of water at such a temperature that the whole hand 
may be indefinitely submerged in it without pain. If complete diges- 
tion of the milk is desired, this application of heat may be continued 
as long as twenty minutes, but in most cases five minutes are sufficient. 
If carried on longer than twenty minutes, the milk will become bitter 
and disagreeable to the taste through the development of peptone in 
excess. 

Immediately after taking the bottle from the hot water it should 
be placed on ice, in order to check further peptonizing and to keep 
the milk from spoiling ; or if the ice is not available the water-bath 
should be quickly brought to a boil in order to prevent further action 
of the ferment, and the bottle corked and then be put in a cool place. 
This recipe may be used where it is thought necessary to digest the 
milk before it is swallowed. Where we desire simply to aid digestion 
it is best to follow the directions already given, except that the bottle 
is not heated, but at once placed upon ice and allowed to remain 
there, being slightly warmed when it is desired to give it to a child, 
or it may be given as a cool and refreshing drink to an adult, the 
heat of the body rapidly causing the ferment to do its work as soon 
as the food enters the stomach. When irritability of the stomach 
exists in adults, this peptonized milk may be made more agreeable to 
the taste by following the directions given in the first recipe, except 
that it must remain in the hot water for no less than two hours, when 
it is poured out into a tin cup or pan and rapidly brought to the 
boiling-point. After this it is strained through a piece of coarse 
muslin and placed upon ice. Before giving it to a patient this mix- 
ture may be flavored with lemon- or orange-juice or any form of acid 
that is desired, without the milk becoming curdled. Peptonized milk 
punch is made from milk prepared in the way already described in 
the first recipe by adding St. Croix or Jamaica rum or brandy, 
and is a pleasant nutrient, particularly if the surface of the liquid 
is sprinkled with a little grated nutmeg. 

406 



PEPTONIZED ENEMA. 407 

A very refreshing and agreeable drink may be made by diluting 
peptonized milk one-half with highly-charged carbonic-acid water, 
and swallowing it while effervescing. 



PEPTONIZED BEEP. 

The following method of preparing Peptonized Beef is recom- 
mended by the Fairchilds, and is very useful, as is also peptonized 
oyster stew, as first introduced by my friend, the late Dr. 1ST. A. 
Randolph. 

Take J pound of finely-minced raw lean beef; cold water, \ pint. 
Mix in a saucepan. Cook over a gentle fire, stirring constantly until 
it has boiled a few minutes. Then pour off the liquor for future use, 
beat or rub the meat to a paste, and put it into a clean fruit-jar with 
\ a pint of cold water and the liquor poured from the meat, and add 

Extracti pancreatis (Fairchild) 20 grains (1.3). 

Sodii bicarb 15 " (1.0). 

Shake well together, and set aside in a warm place, at about 110° to 
115° F., for three hours, stirring or shaking occasionally ; then boil 
quickly. The liquid may then be strained or clarified with white of 
egg in the usual manner, and seasoned to taste with salt and pepper. 

In the great majority of cases it is not necessary to strain the 
peptonized liquor, for the portion of meat remaining undissolved will 
have been so softened and acted upon by the pancreatic extract that 
it will be in very fine particles and diffused in an almost impalpable 
condition, and is therefore in a form ready for assimilation in the 
body. 

Peptonized Oysters. — Peptonized Oysters are prepared by mincing 
six to twelve large oysters, and adding to them, when mixed w T ith a 
moderate amount of their own liquid, 5 grains (0.35) of pancreatin 
or peptonizing powder and 20 grains (1.3) of sodium bicarbonate. 
The cup containing this mixture is now placed in warm water at 
100° F., and allowed to remain there from ten to twenty minutes, 
according to the degree of digestion desired. After this the liquid 
mass is quickly brought to a boil to cook the oysters and stop diges- 
tion, and served with pepper and salt as required. Any condiment 
or flavoring substance may be used. 



PEPTONIZED ENEMA. 

A very useful nutrient enema may be prepared by following the 
directions given above for peptonizing milk, except that an egg, yelk 
and white, should be beaten up in the milk before the ferment is 
added. The effect of this enema may be increased by the addition 
of a teaspoonful to an ounce of whiskey or wine. This should be 
warm when injected into the rectum. 



408 FOODS FOR THE SICK. 



DIGESTED GRUEL. 

Digested Gruel may be made by taking thoroughly boiled hot 
gruel made from oatmeal, barley, wheat, or from arrow-root, to the 
amount of J pint (250 cc), and adding thereto, while it is hot, \ pint 
(250 cc.) of fresh, cold milk ; to this may now be added the contents 
of one peptonizing tube, and the mixture allowed to stand in mode- 
rately hot water or in a warm place for twenty minutes before it is 
placed upon ice. 

KOUMYSS. 

This is a preparation of milk which is very useful for children and 
adults during convalescence from acute or subacute exhausting dis- 
eases. Even young children of three or four years will take a fancy 
to it if it is not made too sour by continuing the fermentation process 
too long. The liquid is prepared as follows : Add to 1 pint (500 cc.) 
of cool, perfectly fresh milk 2 teaspoonfuls (8.0) of sugar, and place 
it, after shaking thoroughly, in a beer or claret bottle. Then add \ 
of a cake of Fleischman's compressed Vienna yeast, and tightly cork 
the bottle, standing it in a warm place or in a water-bath at 99° to 
100° F. for eight to ten hours. Then place in a cool place or on ice 
and use as needed. It must be remembered that the development of 
carbonic gas is very great in this liquid, and that if an ordinary cork 
is inserted it must be tied in before the heat is applied. Further 
than this, the cork must be pulled very gently or the liquid will 
squirt all over the room. The best thing to use when about to drink 
the koumyss is a "champagne tap," by means of which the liquid 
may be drawn off as needed. 



DIET LIST. 

The following bills of fare are used in the Children's Hospital in 
this city with good results, are easily prepared, and the directions 
readily carried out by the inexperienced: 

Diet in Gastro-intestinal Catarrh for a Child of Seven Years. 

Breakfast, 7.30 a.m.: Milk, with lime-water; 4 teaspoonfuls of 
lime-water to each tumblerful of milk. The lightly-boiled yelks of 
two eggs, thin slices of well-toasted bread or stale bread. 

Dinner, 12 M. : A mutton-chop without fat, broiled, or a slice of 
roast beef or mutton, occasionally a bowl of meat broth. Stale bread 
or toast. 

Supper, 7 p. m. : Milk and lime-water. Stale bread or toast, or 
milk-toast. 

For drink : Filtered or boiled water. 

Starch foods to be avoided as much as possible. 



BEEF TEA. 409 

Diet for a Child Ttvo Years Old. 

Breakfast, 7.30 a. m. : Milk. The lightly-boiled yelk of an egg, 
Thin bread and butter (the bread to be one day old). 

Lunch, 11 a. m. : Milk. A thin slice of bread and butter. 

Dinner, 1.30 p. m. : Beef-tea or small piece of minced roast b?ef 
or mutton devoid of gristle. One well-mashed potato, moistened with 
gravy. Bice and milk. 

Supper, 6 P. M. : Milk. Bread and butter. 

For drink : Boiled or filtered water. 

Diet for a Child One Year Old (5 meals a day). 

First meal, 7 A. M. : 2 teaspoonfuls of grated flour-ball (prepared 
as directed below) in J a pint of milk. 

Second meal, 10.30 a. m. : \ a pint of milk with 4 tablespoonfuls 
of lime-water. 

Third meal, 2 p. M. : The yelk of 1 egg beaten up in 1 teacupful 
of milk. 

Fourth meal, 5.30 p. m. : Same as the first. 

Fifth meal, 11 p. m. : Same as the second. 

Flour-ball is to be made by taking one pound of good flour — 
unbolted, if possible — tie it up very tightly in a pudding-bag ; put it 
in a pot of boiling water early in the morning, and let it boil until 
bed-time, then take it out and let it dry. In the morning peel off 
the surface and throw away the thin rind of dough, and with a grater 
grate down the hard, dry mass into a powder. To use this, take from 
1 to 2 teaspoonfuls of the powder, rub it down until smooth with a 
tablespoonful of cold milk, and add 1 tumblerful of hot milk, stirring 
it well all the time. 

Diet for a Child from Six to Twelve Months Old (5 meals a day). 

First meal, 7 A. M. : Mellin's food 1 tablespoonful or flour-ball 
grated 1 or 2 teaspoonfuls (prepared as directed above), hot water 4 
tablespoonfuls ; warm milk enough to make \ a pint. Dissolve the 
Mellin's food or rub down the grated flour-ball in the hot water by 
stirring, then add the milk ; mix thoroughly. 

Second meal, 10.30 a. m., and third meal, 2 p. M. : A breakfast- 
cupful of milk with 4 tablespoonfuls of lime-water. 

Fourth meal, 5.30 p. m. : Same as first. 

Fifth meal, 10.30 p. M. : Same as second. 



BEEF TEA. 

Take 1 pound of lean beef and mince it. Put it, with its juice, 
into an earthen vessel containing a pint of tepid water, and let the 
whole stand for one hour ; strain well, squeezing all the juice from 
the meat. Place on the fire, and slowly raise just to the boiling-point, 
stirring it briskly all the time. Season with salt and pepper to taste. 
In administering this always be careful to stir up the sediment. 



410 FOODS FOR THE SICK. 

Or, take 2 pounds of beef, without fat or bone, half a breakfast- 
cupful of cold water ; place it in a jar in a saucepan of water. Sim- 
mer four hours. 



RESTORATIVE BEEP ESSENCE (Ringer). 

Take 1 pound of fresh beef, free from fat, chop it up fine, and 
pour over it 8 ounces of soft water, add 5 or 6 drops of hydrochloric 
acid and 50 or 60 grains of common salt; stir it well, and leave it 
for three hours in a cool place. Then pass the fluid through a hair 
sieve, pressing the meat slightly, and adding gradually toward the 
end of the straining about 2 ounces more of water. The liquid thus 
obtained is of a red color, possessing the taste of soup. It should 
be taken cold, a teacupful at a time. If preferred warm, it must not 
be put on the fire, but heated in a covered vessel placed in hot water. 

Should it be undesirable for the patient to take the acid, this soup 
may be made by merely soaking the minced beef in distilled water ; 
or, take 1 pound of lean beef, free from fat and skin, chop it up 
very fine, add a little salt, and put it into an earthen jar with a lid, 
such as is used for roasting venison, fasten up the edges with a thick 
paste, and place the jar in the oven for three or four hours. Strain 
through a coarse sieve, and give the patient tAvo or three teaspoonfuls 
at a time ; or, cut up in small pieces 1 pound of lean beef from the 
sirloin or rump, and place it in a covered saucepan, with \ a pint of 
cold water, by the side of the fire for four or five hours, then allow it 
to simmer gently for two hours, skim it well, and serve. 



BARLEY- WATER. 

To prepare barley-water, put two good-sized teaspoonfuls of washed 
pearl barley with 1 pint of cold water in a saucepan, and boil slowly 
down to two-thirds. Strain. 



Barley-water for Adults. 

Take of finest barley \ pound; to this add 1 quart of water and 
boil to 1 pint ; strain and add 1 quart of boiled milk. To this add 
6 ounces each of brandy and lime-water ; sweeten to taste ; flavor 
with nutmeg and rind of lemon rubbed with sugar. This forms a 
most nourishing and palatable drink when kept cold on ice. 



RICE-WATER. 

Rice-water is made by boiling 2 ounces of clean rice in 2 quarts 
of water for an hour and a half. 



BRAN BREAD FOR DIABETICS. 411 



WINE-WHEY. 



Boil 1 pint of fresh milk ; while boiling pour in 1 small tumbler- 
ful of sherry wine (8 tablespoonfuls) ; bring it to the boil a second 
time, being careful not to stir it ; as soon as it boils set it aside until 
the curd settles, and pour off the clear whey. 



ALMOND BREAD FOR DIABETICS. 

Take of blanched sweet almonds \ pound ; beat them as fine as 
possible in a stone mortar : remove the sugar contained in this meal 
by putting it into a linen bag and steeping it for a quarter of an hour 
in boiling water acidulated with vinegar ; mix this paste thoroughly 
with 3 ounces of butter and 2 eggs. Next add the yelks of 3 eggs 
and a little salt, and stir well for some time. Whip up the whites of 
3 eggs and stir in. Put the dough thus obtained into greased moulds, 
and dry by a slow fire. 



BRAN BREAD FOR DIABETICS. 

Take a sufficient quantity (say 1 quart) of wheat bran ; boil it in 
two successive waters for a quarter of an hour, each time straining it 
through a sieve ; then wash it well with cold water (on the sieve) 
until the water runs off perfectly clear ; squeeze the bran in a cloth 
as dry as possible, then spread it thinly on a dish and place it in a 
slow oven ; if put in at night, let it remain until morning, when, if 
perfectly dry and crisp, it will be fit for grinding. The bran thus 
prepared must be ground in a fine mill and sifted through a wire 
sieve of such fineness as to require the use of a brush to pass it 
through ; that which remains in the sieve must be ground again until 
it becomes quite soft and fine. Take of this bran powder 3 ounces 
(some patients use 4 ounces), the other ingredients as follows : 3 
new-laid eggs, \\ ounces (or 2 ounces if desired) of butter, and about 
\ pint of milk ; mix the eggs with a little of the milk, and warm the 
butter with the other portion ; then stir the whole well together, add- 
ing a little nutmeg or ginger or any other agreeable spice. Bake 
in small tins (patty-pans), which must be well buttered, in a rather 
quick oven for about half an hour. The cakes, when baked, should 
be a little thicker than a ship's biscuit : they may be eaten with meat 
or cheese at breakfast, dinner, and supper ; at tea they require rather 
a free allowance of butter, or they may be eaten with curd or any of 
the soft cheeses. 

"It is important that the above directions as to washing and dry- 
ing the bran should be exactly followed, in order that it may be 
freed from starch and rendered more friable. The bran in its com- 
mon state is soft, and not easily reduced to fine powder. In some 
seasons of the year, or if the cake has not been well prepared, it 
changes more rapidly than is convenient, owing to moisture. This 



412 FOODS FOR THE SICK. 

may be prevented by placing the cake before the fire for five or ten 
minutes every day." 



MULLED WINE. 

Boil some spices, cloves, nutmeg, cinnamon, or mace in a little 
water, and add as much of this decoction as is necessary to flavor a 
wineglassful of sherry or any other wine. Add sugar to taste, and 
bring the mixture to the boiling-point. If claret is used, it will 
require more sugar than if a less sour wine is employed. The vessel 
for heating the wine should be scrupulously clean. 



WATERED TOAST. 

Brown several pieces of bread, and carefulW butter the toast so that 
the butter is equally distributed. Place enough salt over the toast to 
flavor it and add pepper to taste. Finally pour as much boiling water 
on the edges of the crust as is necessary to thoroughly soak them, and 
serve to the patient. This is a more agreeable dish than would be 
imagined, and is useful where milk toast is distasteful. 



JUNKET. 

Add from J to 1 teaspoonful of Fairchild's essence of pepsin or 
Parke, Davis & Co.'s pepsin cordial to a pint of milk, which should 
be at body-heat. Place the milk in a cool place, and after the curd 
has formed serve cold and flavor with powdered nutmeg or vanilla. 
If there be too great feebleness of digestion to digest the curd, the 
liquid whey may be given, as it contains the salts and soluble albu- 
minoids. 



PART IV 
DISEASES. 



ABORTION. 



The treatment of abortion divides itself into three parts : the first 
for its prevention, the second for its arrest when threatened, the third 
for its proper care when inevitable. 

In the preventive means we find, as in nearly every branch of 
medicine, that the use of hygienic measures is more important than 
the employment of drugs. If the previous abortions are known to be 
due to syphilis, endometritis, or uterine displacements, these conditions 
must be relieved by the proper remedies. If there exists no apparent 
cause for the interruption of normal gestation, the patient should use 
a simple diet, lead a quiet life, avoid all sexual intercourse, sleep on a 
hard bed, and resort only to gentle exercise. Fresh air is, however, 
a necessity, and should be plentifully supplied. The food should be 
light, but nutritious and palatable, and a sufficient variety supplied to 
avoid any repugnance "to a given dish. In many cases abortion rests 
upon deficient nutrition of the foetus, either by reason of faulty assim- 
ilation on the part of the mother or because of poor food, so that if 
anaemia, debility, or other impoverished states of the maternal system 
be present, these should be treated at once. The clothing should be 
loose, the night's sleep undisturbed and of full length, and the mind 
be set at rest as far as possible in respect to household and other wor- 
ries, and particularly diverted from the thought of possible uterine 
disturbance. 

The use of drugs is to be limited strictly to the fulfilment of a dis- 
tinct indication, and the employment of cathartics is to be avoided, 
the bowels being kept in order by fresh fruits in moderate quantity 
or by mild laxatives, such as cascara sagrada in small dpses and com- 
pound liquorice powder. If these fail, rhubarb may be resorted to, 
and castor oil in capsule may be used. Podophyllin, senna in full 
doses, saline purges in active amounts, and aloes are not to be used 
if they can be avoided. If the woman be exceedingly stout and pleth- 
oric, saline purges are indicated to act as depletants. It is hardly 
necessary to add that elaterium and scammony or jalap are not safe, 
and can only be used if dropsy and ascites are present, and where we 
must choose the least of two evils. Strychnine, which stimulates the 
spinal cord, should never be employed, and cantharides, oil of erigeron, 
and manganese ought not to be used unless they are for some reason 

413 



414 DISEASES. 

very necessary. Although quinine is not of itself abortifacient, it is 
unsafe if an abortive tendency is present, and can only be used in 
cases in which the abortion is brought on by malarial poisoning, when 
it will act as a preventive. 

The only drug which seems to be of any service as a prophylactic 
to be taken all through pregnancy is the fluid extract of viburnum 
prunifolium, the dose of which is J to 1 drachm (2.0-4.0). This drug 
is said to be a uterine sedative and to have no injurious effects upon 
the mother or child. 

Cimicifuga racemosa is probably equally valuable as a prophylactic 
against abortion in the dose of 10 to 20 drops (0.65-1.3) of a good 
sample of the fluid extract, given night and morning. 

The arrest of threatened abortion is one of the most difficult duties 
which come to the physician, and there is no doubt that large doses of 
morphine or opium are the best means of quieting the uterus that we 
have. While viburnum prunifolium may be resorted to, we do not 
know enough of it to rest assured of its value, but it should be tried 
if opium is not at hand or fails. The patient should be at once quietly 
placed in bed in the most comfortable position, be so covered as to 
prevent overheating and taking cold, and receive by the hypodermic 
needle \ grain (0.016) of morphine, or, better still, a rectal injection 
of warm starch-water containing 30 drops (2.0) of laudanum. The 
bulk of the injection should be small in order not to disturb the 
bowels, and must be at the bodily temperature. If this is not done, 
a suppository of the aqueous extract of opium, containing \ to \ grain 
(0.016-0.03), should be used. Ice-cold drinks should be given, and no 
tea or coffee allowed. This treatment quiets the uterus, allays ner- 
vousness and restlessness, and at least puts off the abortion for a few 
hours. Venesection has been practised in very plethoric women with 
advantage. 

When an abortion is inevitable, it is to be treated by measures directed 
to the avoidance of hemorrhages, the thorough delivery of the ovum 
and its appendages, and the prevention of inflammation and septi- 
caemia. For the prevention of hemorrhage a number of balls of 
absorbent cotton tightly wound with thread to the size of a small egg 
should be packed into the vagina back of and around the cervix until 
the bleeding is controlled, and, while a small amount of iodoform may 
be dusted over them before they are inserted, no astringents are to be 
applied, unless it be tannic acid to coagulate the blood in the cotton, 
as astringents cannot reach the bleeding spot. Sponges ought never to 
be used, as they often fail to control the bleeding and rapidly become 
septic. By means of this packing the blood in the uterus cannot 
escape, and, as the uterine walls contract, they urge the liquid between 
the membranes, thereby causing complete separation. Ergot should 
be used after the tampons are applied in the dose of a fluidrachm of 
the extract or a tablespoonful or two of the wine. Generally after 
twenty-four hours the removal of the tampons will shoAv the ovum to 
be in the vagina, but if part of it remains in the uterus, the following 
measures should be resorted to : The administration of ergot should 
be stopped unless the hemorrhages are severe, and the uterine cavity 



ABSCESS. 415 

is to be cleared by the use of the fingers of the attendant, who grasps 
the membranes and draws them away. In skilful hands the curette 
may be employed. If the cervical canal is too small, it must be 
dilated by dilators or by packing it with sponge tents. After the 
membranes are removed the tincture of iodine may be applied to the 
inner surface of the uterus as a haemostatic, antiseptic, and alter- 
ative, or, better still, the uterus should be douched with a 2 per cent, 
solution of creolin in warm water, about a quart being used. 

The after-treatment consists in the use of small doses of ergot and 
quinine, of vaginal antiseptic irrigation^ or even of uterine irrigation 
if it is needed, and the maintenance of perfect rest for one or two 
weeks, or longer if possible. Ergot ought not to be given if there is 
reason to believe that portions of the membranes or blood-clots are in 
the uterus, as by contraction of the os uteri it may imprison materials 
which then become septic. (See Puerperal Diseases.) Should fever 
arise, the uterus should be carefully curetted and the intra-uterine 
douches of creolin continued until the fever disappears. 



ABSCESS. 

The medical treatment of abscess resolves itself into the use of 
drugs to prevent the formation of pus, to cause its fatty degeneration 
and absorption, to quiet the systemic disturbance if the inflammation 
be severe, and to support the body if the suppuration be prolonged 
or in large amount or if debility exists. The treatment may also be 
divided into that suited to acute and that to chronic abscess. 

As acute abscess in its early stages is simply a localized inflamma- 
tion with hyperemia and an outpouring of leucocytes, it may often 
be modified by the use of aconite or veratrum viride in full dose to 
quiet the circulatory excitement and relieve the congestion. This is 
particularly true where the pain is pulsating. At the same time, if 
the swelling is superficial, a poultice, made by moistening bread- 
crumbs with lead-water, should be placed over it, or lead-water may 
be placed on lint and applied in this way. Belladonna ointment 
smeared over the same area may be of service, and the tincture may 
be used internally if aconite cannot be had. If a gland be involved, 
the needle of a hypodermic syringe may be inserted obliquely into 
its centre and 5 to 10 minims (0.3-0.65) of a 2 per cent, solution of 
carbolic acid injected into the swelling. This method has been found 
of singular efficacy in bubo where pus seemed just about to form. It 
is almost always curative, but should not be used in a stronger or 
weaker solution than that named. Another useful abortive method 
for the treatment of the early stages of abscess is the application, 
externally, of a strong solution of nitrate of silver, 20 to 40 grains 
to 1 ounce (1.3-2.6 : 32.0) of water, by means of a camel's-hair brush, 
all over the skin, covering the area involved, or by the use of the 
tincture of iodine in a similar manner. 

Internally, calx sulphurata, in the dose of ^ grain (0.006) given 
every hour or two, may be used as an abortive, or at least to promote 



416 DISEASES. 

arrest and cause absorption. If it becomes evident that pus is going 
to form, then resort must be had to poultices, which by their heat and 
moisture will aid in the formation of pus by favoring the escape of 
leucocytes and by softening the tissues. If pus forms and fluctuation 
ensues, the abscess should be freely opened, drained, washed out by 
a solution of carbolic acid in the strength of 1 : 20, or of bichloride 
solution 1 : 5000, and dressed with antiseptic gauze. If it is tuber- 
cular, the abscess may be opened in the ordinary manner, all diseased 
tissues removed by scraping, and the cavity packed with iodoform 
gauze, or it should be drained by aspiration, and an ethereal solution 
of iodoform injected and allowed to remain in the abscess-cavity if it 
is a small one. The opening is now closed by a pledget of cotton 
wet with tincture of benzoin, and an antiseptic dressing applied over 
it. Not more than 20 grains (1.3) of iodoform should be so used in 
the treatment of tubercular abscess, as larger amounts have caused 
poisoning. 

A very good treatment for slow abscess is to wash out the cavity 
with a 10-volume solution of peroxide of hydrogen. 

If the abscess is chronic (cold abscess) and associated with great 
weakness ; resort must be had to the internal use of iron in the form 
of the tincture of the chloride, cod-liver oil with hypophosphites, qui- 
nine as a tonic to prevent hectic fever, and the use of nutritious, 
easily-digested food. Alcohol may be used and should be given with 
milk or in egg-nogg. 

The following tonic pill or solution is of service : 

R. — Strychnine sulph gr. j (0.05). 

Ferri redact gr. xv (1.0). 

Quininse sulph gr. xx (1.3). — M. 



Or, 



Ft. in pil. No. xx. 
-One t. d. after meals. 



R • — Tr. cinch onse comp. ^ 

Tr. gentian, comp. >- aa f^iij (96.0). — M. 



Tr. cardamom, comp. 
S. — Dessertspoonful (8.0) t. d. after meals. 



Having described the means of treatment, it is to be explained 
how these measures act. The aconite quiets the circulation and 
thereby relieves the inflammation, the lead-water acts locally as an 
astringent and sedative, while the belladonna by its action on the 
blood-vessels contracts the dilated capillaries and allays pain. When 
carbolic acid is injected into an enlarged gland, it acts as an anaes- 
thetic, as an antiseptic, and as an astringent and stimulant. The 
nitrate-of-silver applications act by constringing the blood-vessels, as 
local sedatives, and as counter-irritants. The iodine applications do 
likewise, and also exercise an alterative influence. 

The physiological action of calx sulphurata is unknown. The 
object in using the antiseptic irrigations is self-evident, and the 
employment of iodoform in tubercular abscess rests upon the studies 
of Bruns and Tubingen and many others, who have found by experi- 
ment that the use of iodoform is fatal to the bacillus tuberculosis. 

As large numbers of corpuscles are destroyed in the formation of 



ACNE.— ADENITIS. 417 

pus, and other sources of vitality are sapped by its formation, the use 
of hypophosphites and iron to replace the loss is necessary, and of 
cod-liver oil and tonics to increase the blood-corpuscles and the abil- 
ity to assimilate food. 

ACNE. 

This affection occurs in so many forms and arises from such differ- 
ent causes that a thorough consideration, of its treatment cannot be 
here given : suffice it to state that arsenic is a remedy which will often 
cause a cure and prevent a relapse if used in small doses for a long 
period; that is, 1 to 3 drops (0.06-0.18) of Fowler's Solution three 
times a day for a month or two. This is particularly useful if debility 
and anaemia underlie the disease. If the anaemia be marked, the 
proper treatment is that directed to the cure of this condition (see 
Anaemia) ; if obstinate constipation is present, relief must be obtained 
by saline purges and the bowels kept in order by cascara sagrada or 
some similar drug. If scrofulosis exists, cod-liver oil is of great ser- 
vice, or if much pustulation is present, calx sulphurata, in the dose 
of y 1 ^ to -|- of a grain (0.006-0.008), may be used in pill form three 
times a day. In menstrual acne sulphur may be used internally to 
open the bowels and applied as a wash to the face in the following 
form : 

R.— Sulphuris 3j (4.0). 

Glycerini f^j (32.0). 

Aquae rosse q. s. ad fjviij (250.0). — M. 

S. — Apply twice or thrice a day. 

Or the following may be used in cases of severe inflamed acne : 

R. — Sulphuris iodidi . . gr. xxx (2.0). 

Cerati simplicis Jj (32.0).— M. 

S. — Apply to the parts night and morning. 

If the skin is very atonic, muddy, and torpid, it should be bathed 
night and morning with hot water and castile soap, or even with the 
tincture of green soap, and well rubbed with a wet towel. After this 
the following salve may be thoroughly applied : 

R. — Sulphur, precip. ^ss. 

Lanolin, ) __ „ ,, 

Adepis. 7 aagss.-M. 

S. — Apply as directed. 

If the green soap causes irritation, some bland application should 
follow it, such as simple cerate or the emulsion of the oil of bitter 
almonds. If the pustules be large, they may be incised and vent 
given to their contents, the sac being touched with a drop of carbolic 
acid. If induration is great, ichthyol ointment of the strength of 20 
parts of ichthyol to 100 of lard should be well rubbed in, or resorcin, 
10 to 20 grains to the ounce of lard (0.65-1.3 : 32.0), be applied. Mer- 
curial ointment may also be used to relieve induration, but several 
days must elapse between its use and that of sulphur, as a black 
sulphuret of mercury may be formed and stain the face. 

The diet should be carefully regulated and fatty foods avoided. 

27 



418 DISEASES. 

ADENITIS. 

Adenitis is an inflammation of the lymphatic glands, generally 
arising from scrofulosis, unless there be some speeific trouble, such as 
syphilis, present. Less commonly it occurs in the neck from the irri- 
tation produced by the eruption of milk-teeth, sometimes from blows 
or exposure to cold. 

If the condition consists in a simple enlargement, it should be 
treated by inunctions of iodine ointment and lard, half-and-half, 
night and morning, care being taken that the ointment is stopped as 
soon as any reddening of the skin appears or if fluctuation develops. 
If the ointment cannot be used, the tincture of iodine should be thor- 
oughly painted over the swelling with a brush, but this treatment is less 
efficacious. The following prescription makes a useful application : 

R.— Ichthyol ^iy (16.0). 

Adipis benzoinat £ij (64.0).— M. 

S. — Hub a small piece of the ointment into the swelling t. d. 

Syrup of the iodide of iron, in the dose of 5 to 20 drops (0.35- 
1.3), is to be given if the patient is a child, and tonics must be used 
to improve the systemic condition. As soon as fluctuation or redden- 
ing sIioavs the formation of pus, all this treatment should be stopped, 
and a poultice be applied for twenty-four or forty-eight hours till the 
swelling goes down or is ready for lancing. Lancing is better than 
allowing the abscess to break, as the scar left in after years is a mere 
line instead of a large cicatrix. 

If the enlargement be scrofulous, the following treatment, recom- 
mended by Treves and Grtinfeld, is of value, and should be carried 
out if the patient will submit to it: 

The entire removal of the glands should be effected by dissection 
alone ; directors, handles of scalpels, or fingers should be used to 
separate the glands from the surrounding cellular tissue as closely 
from the capsule as a nerve is cleaned in the dissecting-room. When 
sufficient of the anterior surface is exposed, a .thick thread is passed 
through the gland and drawn gently, when, by continuing the dissec- 
tion, the operator may gradually get to the back of the gland, remov- 
ing portions of the mass at a time. The cavity should be packed with 
iodoform gauze, and the walls scraped if an abscess has existed. 

ALCOHOLISM. 

(See Alcohol.) 

ALOPECIA. 

This disease, when due to a parasite, is best treated, according to 
Crocker, by first pulling out all the loose hairs around the bald spot 
and then painting the affected surface with linimentum cantharidis 
(liquor epispasticus). Three coats of this liquid should be employed, 
and each coat allowed to dry before the next is applied. In other 
cases an ointment of chrysarobin, J to 1 drachm (2.0-4.0) to the 
ounce (32.0) of lanolin, may be used, but care must be exercised that 
too much staining of the skin and clothes does not result Another 



AMBLYOPIA AND AMAUROSIS. 419 

equally good application is 2 grains (0.1) of mercury bichloride to 1 
drachm (4.0) of rectified spirit and 7 drachms (28.0) of oil of turpen- 
tine. This mixture maybe rubbed in with the finder over and around 
the patch. If the patient's skin will stand it, 5 grains (0.3) of the 
corrosive sublimate may be used in place of 2 grains (0.1). 



AMBLYOPIA AND AMAUROSIS. 

Amblyopia (or dull vision) and amaurosis (or blindness) usually 
refer to defective sight or its total loss, the result of functional dis- 
turbance of the retina, optic nerve, or visual centres, and unaccom- 
panied by changes in the eye-grounds in the beginning of the disease. 
These terms, however, also include cases of partial or complete blind- 
ness in which optic-nerve atrophy subsequently develops, and are often 
used to describe ocular disorders not limited by the definitions here 
employed. 

These cases may be gathered into certain groups : 

I. Congenital amblyopias and amblyopias from non-use of the 
eyes. 

In the former there is often a high degree of error of refraction, 
usually far-sightedness ; the latter is seen when an eye is debarred 
from binocular vision by a squint. In both the treatment consists in 
as perfect a correction of the optical error as possible, and, in case 
one eye alone is involved, the separate exercise of its functions. Con- 
genital amblyopias may include incurable defects in the structure of 
an eye. 

II. Amblyopias the result of (a) general diseases or conditions — 
typhoid fever, the exanthemata, syphilis, scurvy, malaria, colds, etc. ; 
(b) local diseases or conditions — hemorrhoids, hemorrhage, pregnancy, 
disordered menstruation, kidney disease, diabetes, migraine, disorders 
of the nervous system, etc. 

The remedies indicated by the special cause are to be employed, 
the medicinal agents most usually needed being mercury, iodide of 
potassium, pilocarpine, particularly in ursemic amaurosis, emmena- 
gogues, and tonics, especially hypodermics of strychnine. As local 
measures repeated fly-blisters to the temples, wet and dry cups, and 
the constant electric current are used. The nape of the neck may be 
cauterized. In hysterical cases metallotherapy may be tried. 

III. Amblyopias the result of the action of certain medicinal and 
toxic agents. 

The abuse of alcohol, and particularly of tobacco, produces a form 
of amblyopia characterized by the development of a scotoma or an 
area in the centre of the field of vision in which the appreciation of 
red and green is lost or greatly diminished. Quinine in excess has, 
in a number of instances, being followed by temporary blindness, 
which is usually denominated quinine amaurosis. Of less frequent 
occurrence are the cases of amblyopia produced by the toxic action of 
salicylic acid, lead, silver, mercury, osmic acid, nitrobenzol, filix mas, 
and the vapor of sulphide of carbon. In all instances the patient must 



420 DISEASES. 

be withdrawn from the influence of the poison ; in tobacco amblyopia, 
in its early stages, this is usually sufficient to effect a cure. The rem- 
edies which have proven of the greatest utility are digitalis, inhala- 
tions of nitrite of amyl, nitroglycerin, and strychnine. Iodide of 
potassium should be exhibited in chronic cases, and always in ambly- 
opias the result of lead-poisoning. The constant current has also 
been employed. 

IV. Amblyopias the result of direct or indirect injury or from 
reflex irritations. 

Traumatic amblyopias may follow a blow upon the eye itself or an 
injury to the skull or spinal cord. To carious teeth, intestinal irrita- 
tions, and the presence of parasites a certain number of amblyopias 
have been attributed, but, while it is not possible to disprove the 
association, such cases must be received with doubt. After the 
removal of the cause strychnine should be exhibited. 

Optic neuritis most frequently depends upon coarse diseases of the 
brain (tumor, abscess) or inflammation of its membranes (meningitis). 
It is also a symptom of numerous disorders — suppression of the 
menses, exposure to cold, rheumatism, anaemia, syphilis, uraemia, 
lead poisoning, etc. The remedies are those naturally suggested by 
the disease or condition which has called it into existence. The prog- 
nosis depends upon the cause. Mercury, iodide and bromide of potas- 
sium, the salicylates, pilocarpine, local bloodletting, and fly blisters 
are the remedies commonly employed. 

Optic-nerve atrophy is either primary or secondary to disease of 
the brain or spinal cord or consecutive to an antecedent neuritis. 
After all irritation has subsided the greatest improvement may be 
expected from hypodermic injections of strychnine, which should be 
pushed to the point of tolerance. Temporary improvement folloAvs 
the inhalation of nitrite of amyl, and, in the hope of improving the 
circulation in the optic nerve, nitroglycerin, digitalis, and similar 
cardiac tonics may be employed. The constant electric current has 
been employed with benefit, especially by voltaic alternations, which 
are more active than simple closures. The following remedial agents 
have also been employed : Suspension, stretching the optic nerve, 
Sequardian injections, nitrate of silver, lactate of zinc, phosphorus, 
and, quite recently, hypodermics of antipyrine. Mercury may be 
used with benefit in early stages of the degenerative process, but is 
of doubtful value in advanced cases. It may be administered in the 
usual manner or by subconjunctival injection in the dose of -^ mg. 
Suspension and injections of testicular juice have little or nothing 
to commend them. 



AMENOKRHCEA. 

This condition depends upon so many causes for its existence that 
it must be treated in many different ways. If anaemia or chlorosis 
shows that there is a deficient supply of blood, measures adapted to 
the relief of such a state are required (see Anaemia), while if plethora is 



ANJEMIA. 421 

a cause depletants in the shape of saline purges are needed, but aloes 
are harmful. In a similar manner, in amenorrhoea due to constipa- 
tion saline and other purges may be used, but the best of these is 
aloes ; and, as constipation and anaemia often exist hand in hand, a 
combination of aloes and iron in a pill is commonly resorted to. 
The iron improves the blood, and the aloes stimulates and congests 
the pelvic viscera by bringing blood to the sexual organs. Aloes 
also increases the assimilation of iron in some unknown manner. The 
following pill is often of service, and is especially recommended by 
Goodell : 

R. — Extract, aloes aqueosi gj (4.0). 

Ferri sulphat. exsiccat ^ij (8.0). 

Asafoetidse ^iv (16.0). 

Ft. in pil. No. c. 
S. — From one to three pills three times a day. 

Cimicifuga has been highly recommended in chronic and appa- 
rently causeless amenorrhoea in the dose of 30 drops (2.0) of the 
fluid extract at the time for a proper flow to occur. Within the last 
few years the binoxide of manganese, in the dose of 1 to 3 grains 
(0.05-0.15), has come prominently forward as a remedy in simple idio- 
pathic amenorrhoea, and is undoubtedly of service, but it should be 
taken for at least two weeks before the date upon which each men- 
struation is expected to occur. Potassium permanganate is also use- 
ful during the same period in similar states, but it is inferior to the 
binoxide of manganese in the author's experience. 

Apiol, the active principle of parsley, may be given in capsules in 
the dose of 3 to 10 grains (0.15-0.65) for the same condition, and 
oils of rue, savine, and tansy have also been employed in capsule in 
the dose of 5 drops (0.1) three times a day. 

In all forms of amenorrhoea a hot sitz-bath at the time for the 
expected " period " is of service, more particularly if the patient has 
" caught cold." The bath should be persevered in for several nights, 
and care should be taken to avoid exposure. Often a little mustard 
added to the water will increase the efficacy of this treatment. 

Under the name of "Dewees's Emmenagogue Mixture," first 
devised by Professor Dewees of Philadelphia, the following formula 
has been largely used in functional and organic amenorrhoea : 

R .— Tinct. ferri. chloridi f^iy (12.0). 

Tinct. cantharidis f&j (4.0). 

Tinct. guaiac. ammon fojss (6.0). 

Tinct, aloes f|ss (16.0). 

Syrupi q. s. ad fgvj (192.0).— M. 

S. — Tablespoonful (16.0) three times a day. 



ANEMIA. 

It is, unfortunately, only too true that the entire subject of blood- 
making and blood-breaking is as yet very imperfectly understood, but 
many of our therapeutic facts rest on rational ground now T , if not before, 



422 DISEASES. 

and if the pathologist will give us more information upon these subjects, 
other remedial measures will be introduced or the empirical employ- 
ment of others still further explained. Practically speaking, the 
therapeutist recognizes two very important points, the causes of which 
the pathologist must eventually solve — namely, that one class of 
anaemias are due to defective or deficient haemogenesis, and another 
to excessive haemolysis. The former are generally believed to form 
the simple class, and the latter the essential or pernicious class. It is 
in the excessive haemolysis class that we fail to produce good results. 
More than this, the causes of excessive haemolysis are so various that 
we can further divide them into removable and permanent, the remov- 
able being represented by the cases in which copraemia or auto-intox- 
ication takes place, and the others by the true pernicious anaemia, 
about which we really know very little, save that most observers find 
evidence of profound haemolysis in the percentage of iron in the liver, 
while in the dark-colored urine they believe a destructive agent exists 
which prior to its excretion has slaughtered many corpuscles. Unfor- 
tunately, it is at present impossible for us to separate clinically the 
haemogenous anaemia from that of haemolytic excess, unless we find 
evidence of great corpuscular disintegration in a copious elimination 
of haemoglobin in the urine, or a jaundice evidently haematogenous in 
character, or a large number of defective corpuscles, which would per- 
haps indicate defective haemogenesis rather than that they were 
scarred veterans of a battle with a poison in the liver-cells or else- 
where. Post-mortem signs often aid us in the differential diagnosis, 
but this is too late to be of any benefit to the doctor or patient. 

There is one point, however, about which there can scarcely be 
any doubt, and that is that in many cases iron is greatly abused, being 
given when there is no indication for it or more frequently given in 
excessive dose. By excessive dose the author refers to as much as 6 to 
10 grains in a day of reduced iron. The amount of iron in the human 
body is very small, and every study ever made of its absorption and 
elimination after absorption has shown that these processes are very 
slow. Hamburger recovered from the faeces nearly all the iron admin- 
istered, and Jacobi proved that even when the iron was injected into 
the veins 10 per cent, was at once eliminated by the bowels, liver, 
and kidneys, and the remainder deposited in the liver, spleen, and 
other tissues in the same manner as is any metallic substance. The 
researches of Gottlieb have also been in confirmatory lines. When 
we consider that there is in the human blood only about 39 grains of 
iron, all told, we can see that the use of 12 grains a day in the course 
of a little over three days places a double quantity of the metal in 
the economy, which is not needed, and is either cast out or deposited 
at any convenient spot, there to lie undisturbed until it can be 
extruded. 

Much, of course, depends upon the cause of the anaemia, but there 
is only one excuse for the use of the doses just named — viz. a condition 
of the digestive apparatus which results in the formation of a sul- 
phide of iron in great quantity, so that only an infinitesimal amount 
escapes into the system. This perhaps explains the empirical fact that 



ANJEMIA. 423 

in some cases of chlorosis or intense anaemia iron has to be given in 
large doses to accomplish any good. 

One of the best and most recent papers on this subject is that of 
Ralph Stockman, who gives a masterly summary of the subject of 
the absorption of iron in chlorosis. In this summary he points out 
that we have three chief theories as to the action of iron in anaemia. 
The first, the absorption theory, is based on the fact that as iron is 
taken into the body with the food, the iron of the haemoglobin must 
be obtained from this source, and therefore that medicinal iron given 
by the mouth must be absorbed. The second theory rests upon the 
belief that iron is not absorbed when given by the mouth in addition 
to that in the food, but simply acts as a stimulant to the mucous 
membrane of the alimentary canal, therefore increasing the digestion 
of food, and so overcoming anaemia by the general improvement coin- 
cident upon proper nutrition. The third theory is that of Bunge — 
namely, that in chlorotic conditions there exists an excess of sulphur 
or sulphuretted hydrogen in the bowel, which changes the iron in the 
food into a sulphide of iron, which Bunge states cannot be absorbed. 
He believes that the inorganic iron which is given as a medicine saves 
the organic iron of the food by combining with the sulphur, and so 
indirectly cures the anaemia by the protection afforded the food-iron. 
It is important to remember that each of these theories has been 
supported by many careful experiments, but it is also well to bear in 
mind that the hypotheses and the experiments supporting them may 
be erroneously based. Thus, we have no right to imagine that the 
inorganic preparations of iron have a stimulating power over the ali- 
mentary mucous membrane, or, even if they have, that this power is 
exercised in the peculiar line of aiding in the absorption of the 
organic iron of the food. Again, the researches of Hamburger, 
Damaskin, Gottlieb, Muller, Jacobi, and Socin, which show that after 
the internal use of inorganic iron there is no increase in the iron in 
the urine, are valueless so far as the conclusions drawn by them are 
concerned — namely, that as there is no increase in iron in the urine, 
there is none in the blood, and therefore it is not absorbed. These 
conclusions are not justified, because they are based on the erroneous 
view that because iron is not in the urine it is not in the blood, and 
because it is not in the blood it is not absorbed. Every one know x s 
that in the case of chronic lead poisoning, w T hen the body is saturated 
with the metal, there is often no lead in the urine, the poison being 
deposited in the tissues ; and if this is true of lead, it may be of iron. 
Particularly is this to be remembered when we find Stockman quoting 
the researches of Mayer, Bidder, and Schmidt, and a host of others, 
who have proved that we are not to look to the kidneys as the path 
for the excretion of iron, but to the intestinal walls. Finally, Stock- 
man has proved that when iron is used hypodermically it cures anae- 
mia when it cannot stimulate the digestion or counteract sulphides. 

We learn from practical experience several things which science 
does not tell us — namely : Iron will not cure all cases of anaemia, 
even if they belong to a functional type, but other methods must be 
resorted to at the same time or separately for their cure. The insol- 



424 DISEASES. 

uble salts of iron are better remedies for absorption than the soluble 
salts, because they are not precipitated in the stomach, and for this 
reason reduced iron is the best chalybeate for uncomplicated cases. 
Besides using iron in this form, we should employ laxatives if the 
bowels are confined; mineral acids, particularly nitric and nitromuri- 
atic, for their effect on the function of the small intestine and liver; 
and, in addition, bitter tonics of a more or less simple form, accord- 
ing to the exigencies of the case, using quinine if malaria seems lurk- 
ing in the body, simple bitters if the stomach lacks tone, aromatic 
bitters if from atony of the muscular coats the digestive tract seems 
sluggish, with a resulting formation and accumulation of flatus and 
digestive juices. 

The preparations of iron best employed in anaemia are the insol- 
uble salts just named, such as Quevenne's iron and the carbonate, 
but there are indications which must be regarded as to the salt to be 
used. In many anaemic persons, particularly females, the tongue is 
broad and white, not from coating, but pallor — is flabby and torpid- 
looking. Under these circumstances the bowels should be kept mov- 
ing by mild purges, and the sulphate or some other astringent prepa- 
ration of iron be taken by the patient. In the anaemia caused by 
rapid childbearing and lactation cod-liver oil, the hypophosphites 
and phosphates of lime, should be used, while the iron and quinine in 
tonic dose may be of service in all forms of the disease. With some 
practitioners Blaud's pill is very much used, made as follows : 

R. — Ferri. sulph. exsiccat. \ -- .. ,„ ^ 

Potassii carbonatis / • o J v • /• 

Syrupi q. s. — M. 

Ft. in pil. No. xlviii. 
S. — One to three pills three times a day, after meals. 

Although it is perfectly true that we have almost no knowledge 
of the manner in which alteratives act in instances of disease where, 
through morbid functional activity, enlarged glands or growths 
appear, it is evident that they must act upon the trophic nerves or 
directly upon the nourishment of the affected parts. If they are 
used in large quantities, they act as depressants to the normal nutri- 
tion of the body, producing primarily a decrease in the vitality of 
morbid growths, so that they melt down and disappear, and they may 
finally so reduce the condition of the healthy tissues as to cause 
sloughs and ulcerations. Whether these changes are due to over- 
stimulation of nutrition — that is, to an excessive trophic change — 
or whether they depend upon actual lowering of the tone of the parts, 
we do not know. One thing we do know, however, and that is that 
small doses of most of the so-called alterative drugs act as very dis- 
tinct stimulants to the development of normal structures, and in no 
instance do we find this more typically represented than in the effect 
which they exert upon the blood. Quite a number of years ago 
Keyes of New York emphasized the value of minute doses of mercury 
bichloride in syphilitic and other anaemias, and abundant clinical 
observation has certainly confirmed his views. The dose of bichloride 



ANAL FISSURE. 425 

of mercury in anaemia should be about fa of a grain (0.0016). Not 
only will minute doses of the bichloride of mercury act in this way, 
but small amounts of calomel or mercury itself will have such an effect. 

Inunctions of very small amounts of mercurial ointment once a 
dav or every other day, in adults and in children, will increase the 
fulness and redness of the cheeks and lips and the number of the 
corpuscles, the piece of ointment used being no larger than the half 
of a very small pea. This treatment will be found of service in cases 
not necessarily dependent upon specific taint or scrofula. The marked 
increase in the nutrition of children of a syphilitic taint who are suf- 
fering from marasmus under the internal use of gray powder and such 
inunctions gives further evidence of this fact. 

Arsenic also is of value in anaemic conditions, and may be em- 
ployed in relatively larger doses than mercury, but, nevertheless, 
smaller amounts than are usually given in chorea and similar states. 
Osier has shown the value of the drug in anaemia, and so has Barton 
in England. Any one of the preparations of arsenic may be employed, 
but not more than -fa grain (0.004) of arsenous acid should be taken 
in a day, although more has been used with no less benefit to the 
patient. Most of the drug, under these circumstances, is in excess, 
and is cast off in the urine and faeces unused and wasted, straining 
and irritating the emunctories of the body during its passage through 
them. 

Arsenite of copper is also a remedy of very considerable value 
under these circumstances in the dose of from fa-^ to fa of a grain 
(0.0006-0.003) three times a day. 

Bullock's blood, fresh or dried and redissolved, may be used by 
the rectum in the treatment of anaemia in those cases where iron 
fails, and a change of air and diet may often produce a cure which no 
drug can bring about. 

Diet is an important part of the treatment of anaemia. The food 
should be good, well flavored, and varied, as well as easy of digestion. 
It should contain, as far as possible, the remedies needed by the sys- 
tem, such as bone salts, iron, and alkalies, and should be accompanied 
by some red wine, such as port. 

At present we may conclude that pathology has not found out the 
real cause of these troublesome cases, and that until physiology can 
put its finger upon the most intricate mechanism of blood-making 
with a positive, clear statement of its function and the physiological 
chemistry of the manufacture of haemoglobin, we must remain satis- 
fied to resort to the remedies which experience or common sense tells 
us will be of value to our patients. 



ANAL FISSURE. 

This is one of the most painful affections to which man is subject, 
and requires intelligent treatment, generally by surgical means if the 
result is to be curative, although great relief can be obtained by the 
use of drugs. 



426 DISEASES. 

The most painful and annoying feature of the lesion is the vio- 
lence of the pain on defecation, which is so severe that any emptying 
of the bowel is impossible except on rare occasions, when the pain is 
concentrated in one effort. 

To relieve this pain and enable the patient to have a fairly com- 
fortable stool, nothing is so good as an iodoform suppository contain- 
ing 2 to 10 grains (0.1-0.65) of the drug. Iodoform being a local 
anaesthetic, the passage takes place almost without the patient's 
knowledge. If much spasm of the sphincter is present, extract of 
belladonna, \ grain (0.015), may be added to each suppository. For 
the cure of the fissure a drop of strong carbolic acid may be applied 
to the spot, and a lotion of tannic acid, glycerin, and water used if 
hemorrhoids are also present. Ringer highly recommends the appli- 
cation to the fissure, by means of a brush, of a solution of bromide 
of potassium, 1J drachms to 1 ounce (6.0 : 32.0) of glycerin. In 
order that the passages may be soft and yet the patient not be purged, 
sulphur should be given in the dose of 20 to 40 grains (1.3-2.6) every 
night, or, if this cannot be used, castor oil may be given. 

The best way to give the sulphur is by combining it with powdered 
cinnamon or aromatic powder. Sometimes relief is obtained by the 
use of flexile collodion painted over the fissure. 

ANEURISM. 

The treatment of aneurism by drugs is, unfortunately, not very suc- 
cessful, but is at least worthy of trial in all cases. Vascular disease 
resulting in such a lesion depends upon so many causes which may 
modify the treatment that the history of the case should be well borne 
in mind. The most common causes are syphilis, rheumatic taint, and 
traumatism, and very often injury is superimposed upon one of the 
systemic taints named. Whatever the cause of the disease may be, 
iodide of potassium is par excellence the remedy most apt to do good, 
and it will nearly always give relief, even if it does not cure. The 
doses should be large, 10 to 20 grains (0.65-1.3) three times a day 
if the patient will bear them, and the prognosis under this treatment 
is far more favorable if the cause be syphilis than if the disease be 
idiopathic or traumatic. 

For successful treatment the recumbent position must be insisted 
upon and the patient kept quietly in bed, changing his position 
as little as possible and confining himself to the most simple 
and easily digested diet, with entire avoidance of all stimulat- 
ing substances either in the way of food or drink. Often an 
absolute milk diet is to be adhered to. If the heart is excitable 
and irregular and the vascular system irritable, with a high arterial 
tension, the circulation must be quieted by small doses of veratrum 
viride, say 1 or 2 drops (0.05-0.1) twice or thrice a day, but dig- 
italis is not to be employed, since it increases the strain upon the 
aneurismal sac, although it does quiet the irregular heart beat. 
Aconite may also be used with care, but it is inferior to vera- 
trum viride. If the pain be very great — and it often is severe, par- 



ANGINA PECTORIS. 427 

ticularly at night — opium is indicated and sleeplessness should be 
allayed, not by full doses of morphine, but of morphine and chloral ; 
or, better still, croton-chloral should be so ordered that the patient 
receives -^ grain (0.075) of morphine and 10 grains (0.65) of croton- 
chloral in pill at bed-time. All attempts to cure aneurism by the 
use of other drugs, unless syphilis indicates mercury, are useless 
when the lesion is thoracic or abdominal, and when it occurs in the 
extremities, as in popliteal aneurism, surgical measures are to be 
resorted to as the chief means of cure. If dyspnoea in thoracic 
aneurism is marked, slight inhalations or " whiffs " of chloroform are 
useful. 

As we do not know how alteratives act, other than that they gov- 
ern nutrition, we cannot explain the value of iodides in aneurism. 

ANGINA PECTORIS. 

The exact pathological changes existing in angina pectoris are 
by no means clearly understood, but without doubt many cases are 
due to spasm of the blood-vessels, which results in distention of the 
left side of the heart, which organ is already dilated or enfeebled by 
disease. Often, too, the coronary arteries have undergone athe- 
romatous changes, thereby aiding in the cardiac debility Remedies 
w T hich ordinarily relieve pain act too slowly or too feebly to be of 
service in angina pectoris, and if successful would only relieve the 
symptom without removing the cause. The indication in the great 
majority of cases is to relax the vascular spasm, this relieving the 
overburdened heart. As first pointed out by Brunton, the nitrites 
possess this power, and to him belongs the credit of first applying this 
class of drugs to this ailment. All the nitrites are useful, but the nitrite 
of amyl and nitroglycerin are the best remedies for the attack itself, and 
the nitrite of potassium or sodium for the intervening periods or where 
the paroxysm is prolonged. The reason for this lies in the fact that 
the sodium and potassium compounds are more stable than the other 
two compounds, are more slowly broken up in the body, and therefore 
more prolonged in their effects. In an attack a few drops of the 
nitrite of amyl should be given by inhalation from a handkerchief, or 
the nitroglycerin can be used in the dose of 1 drop of a 1 per cent, 
solution by the mouth. The dose of the sodium and potassium nitrites 
is 3 grains (0.15) three times a day, but all these drugs are useless 
unless the arterial tension is high and the heart throbbing or irreg- 
ular in its exercise of power. If vascular relaxation is present, they 
should be supplanted by stimulants, such as alcohol, in full dose, in 
warm water. 

Digitalis tincture in the dose of 10 drops (0.65) may be given 
hypodermically during the attack to stimulate the heart if it is weak, 
and between the attacks to improve its condition. The writer has 
found 20-grain (1.3) doses of antipyrine of great service in some 
cases. Ether given hypodermically is often of service, but Hoff- 
mann's Anodyne may be used by the mouth or hypodermically 
instead of ether with better results. 



428 DISEASES. 

If the nitrite does not relieve the pain, or if it cannot be used 
because of some contraindication, morphine must be given hypoder- 
mically in the dose of J to \ grain (0.016-0.03), but it should never 
be given by the mouth under these circumstances, as its absorption 
will be too slow and its effects will come on after the pain has ceased. 

The cure of the patient rests upon the elimination of all causes which 
can possibly produce a nerve-storm from cardiac irritability, and in the 
administration of arsenic in full dose for long periods of time. Phos- 
phorus is another remedy which is of undoubted value, and should 
always be tried in the dose of t ^-q- grain (0.0006) three times a day 
after meals. 

The following is a valuable prescription for use between the attacks : 

R— Tine, digital TT^xlviij (3.0). 

Tine, strophanthi rt\,xlviij (3.0). 

Nitroglycerini (1 percent.) TT^xxiv (1.6). 

Tine, cardamomi q. s. f^iij (96.0). — M. 

S. — Teaspoonfnl (4.0) three times a day. 

The diet should be moderate and easy of digestion, and salads, 
lobster, and similar articles of food abandoned. If the patient is 
inclined to take exercise of a violent character, he must be restrained, 
but some exercise must be insisted on if it is possible. 

Tonics, fresh air, freedom from mental worry and avoidance of 
exposure and cold are also necessary, and running for a car, or per- 
forming any act calculated to suddenly increase arterial pressure and 
cardiac work, is to be avoided. 

Cocaine has been highly recommended for the cure of angina pec- 
toris, but is as yet untried, except in a few cases. 

In that form of angina pectoris occurring in nervous females, some- 
times called pseudo-angina pectoris, 1 drachm of ether in ice-water or 
capsule will often abort the attack, or if the paroxysm is caused by 
dyspepsia and if the stomach be overloaded, the sufferer may be 
relieved by the stomach-pump. Between the attacks aconite tincture 
in the doses of 2 to 3 minims (0.1-0.15) three times a day is useful. 



ANOREXIA. 

Anorexia is only a symptom of disease, generally associated with 
debility or other systemic disorder, such as fever or many exhausting 
diseases. 

It is best treated by a careful diet, the use of the bitter tonics, 
such as gentian, cardamoms, and the mineral acids, or by the use of 
one of the following prescriptions : 

ri .— Acid, arsenosi gr. \ (0.03). 

Extract, nucis vomicae gr. iv (0.3^. 

Quinina? sulph gr. xx (1.3). — M. 

Ft. in pil. No. xx. 
S. — One t. d. after meals. 
Or, 

R— Acid, hydrochloric! dil fgss (16.0). 

Tinct. cinchona? corap f^vj (192.0). — M- 

S. — Dessertspoonful (8.0) three times a day, after men Is, well diluted with water. 



APOPLEXY. 429 

(For the use of other bitter tonics see Calumba, Quassia, Chamo- 
mile, Cardamom, and Nux Vomica.) None of these drugs are suit- 
able if there is any acute irritation or inflammation of the stomach 
or intestines. (See Indigestion.) 



APOPLEXY. 

When a person suffers from a stroke of apoplexy, the chief aim 
of the physician must be to lower the blood-pressure, and so to 
decrease hemorrhage, and, as the blood-pressure is nearly always 
excessive under these circumstances, its reduction may be considered 
as a routine treatment. If the person be at all fall-blooded, copious 
venesection is to be employed, any one of the veins in the arm on its 
anterior surface being most convenient. (See Venesection.) At least 
1 pint (500 cc.) should be withdrawn and the condition of the pulse 
carefully noted. If bleeding is impossible, veratrum viride or aconite 
must be used to lower blood-pressure, the latter in full dose, 5 drops 
(0.35) of the tincture. Hot mustard plasters must be applied to the 
feet, or a warm mustard foot-bath be used if this is practicable. Ice 
in an ice-bag or wrapped in a towel may be applied to the head, and 
if vomiting comes on care must be taken that the stertorous breathing 
does not draw into the lungs particles of the half-ejected food. Some- 
times croton oil, 1 drop (0.05), placed on the tongue with 5 drops 
of sweet oil, may cause a depletant catharsis, or jr grain (0.01) of 
elaterium may be used. The head must be kept high and the feet low 
down. These are the methods to be used immediately after the rup- 
ture of the blood-vessel. 

The object to be sought, after the " stroke " has occurred and the 
hemorrhage has ceased, is the removal of the extravasated blood, the 
restoration of function in the paralyzed parts, and the prevention of 
secondary lesions consequent upon inflammation of the brain as a 
result of the injury to its substance. If the patient survives the 
attack, no drugs should be used save arterial sedatives for one or two 
days, until the clot in the ruptured vessel has become firmly fixed, 
unless symptoms of meningitis arise, when these drugs must be 
pushed, and opium and calomel administered in small antiphlogistic 
doses, I grain (0.016) of each every four hours. Meningitis and 
cerebritis rarely occur if the veratrum viride or aconite is properly 
used. After the clot has firmly formed and has plugged the blood- 
vessel, we may proceed to take measures for the absorption of the 
exudate, the chief measure consisting in the use of iodide of potas- 
sium in as large doses as the patient will bear without the production 
of iodism. This drug should not be resorted to until several days, or 
even two or three weeks, have elapsed after the attack. Mercury in 
small doses may also be given. 

In order that the muscles of the extremities may not waste and 
become powerless from disuse, passive exercise, rubbing, and, if pos- 
sible, massage, must be resorted to. Electricity may be applied to 
them in the form of the slowly-interrupted current, and strychnine 



430 DISEASES. 

may be used hypoderruically or by the mouth as a stimulant to the 
trophic centres in the spinal cord. None of these measures are to be 
employed if any inflammation exists in the brain, as they will increase 
the cerebral disorder, and at least three Aveeks should elapse after the 
attack before they are resorted to. 

Electricity applied to the head to remove the lesion is useless, as 
the current does not go through the brain, but around the skull by 
means of the scalp. 

A very careful diet is to be maintained. Meats are to be used 
very sparingly, the bowels maintained in perfect regularity, and no 
wines are to be taken nor any stimulants used, lest they cause a 
second rupture of the weakened vessel in the brain. 

Apoplexy must be carefully differentiated from acute alcoholism 
and opium poisoning, which it much resembles. (See Alcohol.) 

If respiration fails, nothing can be done with much advantage, but 
belladonna or strychnine may be given hypodermically. The use of 
electricity to stimulate the phrenic nerve and diaphragm when respi- 
ration fails is a remnant of senseless medical practice, and is partic- 
ularly useless in apoplexy. (See Asphyxia.) 

Above all things, stimulants are contraindicated during the acute 
attack, even though the pulse fails, as they increase the hemorrhage 
into the brain. 



APPENDICITIS. 

It is to be remembered that many cases which years ago would 
have been called idiopathic peritonitis are now recognized as arising 
primarily from inflammation of the appendix vermiformis. For this 
reason it is incumbent upon every physician who is called to see a case 
of severe abdominal pain with symptoms of peritonitis or appendi- 
citis to carefully examine into the condition of this part of the intes- 
tine. No routine treatment for appendicitis can be followed, as each 
case possesses distinct individuality. There are many surgeons, hold- 
ing extreme views, who assert that the mere presence of appendicular 
inflammation for a few hours renders an extirpation of this organ ne- 
cessary. On the other hand, there are doubtless many cases in which 
the physician postpones consultation with a surgeon until it is too late 
to save the patient. All cases of appendicitis may be divided into 
three classes : First, those which are fulminating or gangrenous, and 
almost invariably result in death whether treated medically or surgi- 
cally ; second, those which need surgical interference ; and third, 
those which undoubtedly get well, some of them permanently so, 
under proper medical treatment. With the first class we shall not 
deal, for obvious reasons. In all cases of appendicitis of the third 
class which we have named the method to be followed is briefly as 
follows : The patient is to be put to bed and absolute rest on the back 
insisted upon. He must not rise to the sitting posture even for def- 
ecation or urination. An ice-bag is to be placed over the appendix, 
or, if this cannot be done, leeches may be applied in this region. The 



ASPHYXIA. 431 

bowels are to be moved by half to one ounce of magnesium sulphate 
or citrate of magnesium in its official solution, and, as soon as this 
purgative has acted thoroughly, sufficiently large doses of opium or 
morphine are to be given to relieve pain and act as an antiphlogistic. 
The doses should not be large enough to stupefy the patient, so that 
he fails to give clear answers to questions. If in spite of this treat- 
ment there is persistent tenderness in the right iliac region, with in- 
crease in the area of dulness on percussion over the appendix, and a 
sense of deep-seated tension exists, then a surgeon should be at once 
called in — not, necessarily, to operate, but to decide as to the advisa- 
bility of an operation, and to perform it if it is considered a wise pro- 
cedure. Generally, it is best to postpone surgical interference in 
mild cases until after the acute attack is over, but this preference is 
to be waived in pressing cases. 

In the second class of cases which we have named the treatment 
is too largely surgical to be considered in a book devoted only to 
medical therapeutics. It is unnecessary to give a purgative before 
the operation, unless we think the bowel contains undigested food, 
since the caput coli never contains faeces in any quantity, and, 
furthermore, in those fairly severe cases which demand operation 
at once the possibility of perforation of the appendix, with escape 
of the contents of the bowel into the peritoneal cavity, is always 
to be remembered, for if perforation has occurred the purgative will 
force the faeces out through the patulous appendix. Instead of a 
milk diet, the patient should receive a diet of broths or beef-tea, 
since the casein in the milk is apt to cause fermentation and the 
formation of gas in large amounts in the intestine, thereby causing 
distressing tympanites. 

If attacks of appendicitis are recurrent, the appendix should be 
removed in an interval of quiescence. (See Article on Peritonitis.) 



ASPHYXIA, 

When practising artificial respiration in cases of asphyxia Sylves- 
ter's method should always be employed. This consists of laying the 
patient on some hard, flat surface, kneeling above his head, and then, 
after grasping the arms at the elbows, bringing them upward and 
outward, so that they follow the plane on which the body is extended. 
This movement causes expansion of the chest, or inspiration. After 
a moment's pause the arms are lifted up and brought toward one 
ano:hei\ and then, while still approximated, pushed down to their 
original position upon the floating ribs, upon which they are pressed. 
This last movement drives out the air from the chest, or causes expi- 
ration. These movements should be at the rate of from sixteen to 
twenty per minute, about that of normal respiration, and be persisted 
in for at least forty-five minutes, even though the case seems hope- 
less, as cases have recovered after as long a period of apparent death 
as an hour. While they are being carried on the patulousness of the 
upper air-passages is to be maintained. 



432 DISEASES. 

In some researches made by Dr. Martin and the writer the follow- 
ing rules regarding the position of the head, neck, epiglottis, and 
tongue were formulated : The fingers are passed behind the angles 
of the lower jaw and the latter is pressed forward; this elevates the 
epiglottis and the base of the tongue about a quarter of an inch from 
the post-pharyngeal wall. Extending the head and pushing it for- 
ward so that the neck makes an angle of forty -five degrees with the 
plane of the table draws the base of the tongue and the hyoid bone 
far forward, this motion being at the same time imparted to the epi- 
glottis, so that the latter stands upright and is separated from the 
posterior wall of the pharynx by an interval of about an inch. By 
tightly closing the jaw the antero-posterior space is still further 
increased. 

The epiglottis may prevent free entrance of air to the lungs, even 
though the tongue is pulled forward. Any means which accom- 
plishes the anterior projection of the hyoid bone immediately and 
infallibly raises the epiglottis and the base of the tongue, and the 
hyoid bone may be made to project anteriorly by direct pressure 
upon its cornua, by direct pressure or traction applied to the tongue 
far back behind the anterior half arches of the palate, and by the 
action of gravity in the abdominal decubitus, or by extension of the 
head upon the neck, although flexion of the neck with extension of 
the head upon the neck does away with the epiglottis as an obstruct- 
ing factor as completely as any other posture. 

The absurdity of the application of the rapidly-interrupted cur- 
rent to the phrenic nerve is not alone dependent upon the points we 
have named. It has recently been proved by careful observation on 
the part of Dr. Martin and the author that the application of the 
electrode over the phrenic nerve in the neck may cause cardiac arrest 
through diffusion of the current to the vagus nerve, and Griswold 
reached conclusions of an identical character in the year 1885. 

If electricity is used, it should be employed solely as a peripheral 
irritant, with the object of arousing the patient, as would a dash of 
cold water. 

ASTHENOPIA. 

Asthenopia, or weak sight, depends upon exhaustion of the power 
of accommodation in cases of refractive error, usually hypermetropia, 
or upon insufficiency of the external ocular muscles. The former is 
sometimes called accommodative asthenopia, and the latter muscular 
asthenopia. The treatment of these conditions requires the prescrib- 
ing of the proper pair of glasses, combined, if necessary, with prisms 
and with systematic exercise of the ocular muscles. Locally, a weak 
solution of the sulphate of eserine or pilocarpine acts as a stimulant 
to the ciliary muscle, and internally good results follow the use of 
large doses of the tincture of nux vomica or strychnia. 

R .— Eserinse sulph gr. & (0.002). 

Aq. destill f^j (32.0)— M. 

S. — 2 drops (0.1) night and morning. 



ASTHMA. 433 

Or, 

R.— Pilocarpin. nitrat gr. fa (0.003). 

Aq. destill f£j (32.0).— M. 

S. — 2 drops (0.1 ) night and morning. 

Another form of asthenopia is termed neurasthenic asthenopia or 
retinal anaesthesia, and presents a number of eye-symptoms in con- 
nection with a general depression or debilitated state of the nervous 
system, the eye itself, however, being a healthy organ. The chief 
symptoms are fluctuation in visual acuity, rapid disappearance of 
objects looked at, contraction of the field of vision, imperfect retinal 
images, often associated with dread of light. The mere prescription 
of glasses in these cases to correct any refractive error is not suf- 
ficient. Much relief will often be obtained if hot compresses at 110° 
F. be made to the closed eyelids for five minutes at a time. The 
patient requires the same general treatment that would be applied to 
any neurasthenic case. All the functions of the body must be care- 
fully examined into and placed in as normal a condition as circum- 
stances will allow. Especially valuable are rest, massage, salt baths, 
and full closes of strychnia, together with iron if there be anaemia. 



ASTHMA. 

Asthma is one of the most difficult diseases to successfully treat 
that the physician has to deal with. 

The disease in all its forms depends upon interference with the 
free entrance and exit of the air to and from the lungs, and this is 
generally, if not always, dependent upon a spasm of the muscular 
fibres in the walls of the bronchial tubes, although it has been 
asserted to be due to a sudden swelling or hyperemia of the bronchial 
mucous membrane. Both of these states are probably present in 
varying degree in all cases 

The spasm has been proved by Longet, Williams, Romberg, Paul 
Bert, Bierner, and very recently by Sandmann, to be due to a neurosis 
of the pneumogastric or vagus nerve, while the swelling of the mucous 
membrane has been seen by Stoerk and others. This has formed 
two schools of teaching concerning the pathology of this disease, 
Avhen a little attention to the physiology of the subject would at least 
show that no difference need exist, the vagus nerves governing not 
only the muscular fibres, but also the blood-vessels of the bronchial 
tubes. The discovery of Michaelson that injury of the recurrent 
laryngeal nerves causes catarrhal inflammation of the bronchial tubes, 
particularly those of the upper lobes, renders the analogy between 
acute asthma and laryngeal spasm which has been spoken of by 
many writers still more interesting. 

One other step remains for a thorough understanding of the man- 
ner in which the disease is produced. Gastric, dyspeptic, or intestinal 
asthma arises from indigestion, as its name implies, and is caused by 
the irritation of the afferent filaments of the vagus in the walls of 
the stomach and intestine, thereby causing reflexly a contraction and 

23 



434 DISEASES. 

hyperemia of the bronchial tubes. In a similar reflex manner hyper- 
trophies of portions of the nasal chambers or abnormal conditions of 
the nasal mucous membranes in general may result in an asthmatic 
attack. 

Having obtained some idea of the cause of an attack, let us turn 
to the treatment of the affection. 

By far the most serviceable remedy in asthma is belladonna, which, 
as has been pointed out when that drug was studied (see Belladonna), 
exercises in medicinal dose a decided sedative and depressing influ- 
ence on the peripheral filaments of the vagus nerves, not only so far 
as the heart is concerned, but also, through the pulmonary fibres, upon 
bronchial secretion, which is always diminished by the drug, probably 
by this vagal influence. 

It is evident, therefore, that the use of belladonna or atropine, 
although originally employed in an empirical manner, is really based 
upon rational ideas, and as the physiological action of stramonium, 
hyoscyamus, and similar members of this group is nearly identical 
with belladonna, their influence for good is also explained. The 
experiments of Ott proved that lobelia is a peripheral pneumogastric 
depressant, and those of Rosenthal and the author likewise showed 
that tobacco has a similar effect. The same is also true of nitrite of 
amyl and the other nitrites, which also relax unstriped muscular 
fibre. We have before us, therefore, a list of the most efficacious 
and best antiasthmatics, all of them being depressant to the periph- 
eral vagi. 

The other remedies commonly employed are chloroform by inhala- 
tion, which relaxes the spasm of muscular fibre by its local influence, 
and morphine, which acts as a nervous sedative, prevents reflex irri- 
tation, and quiets the patient, acting at the same time as a heart stim- 
ulant and unloading the engorged cardiac cavities. The relief obtained 
by the inhalation of the fumes of nitrate of potassium, See asserts, 
depends upon the formation of the protoxide of nitrogen and carbonic 
acid gas, which act as local ansesthetics. 

The practical treatment of an attack of asthma consists in the use 
of morphine hypodermically in the dose of jf to J grain (0.01-0.015), 
alone or in combination with atropine. Cigarettes made of paper 
soaked in a solution of nitrate of potassium and belladonna may be 
used (see formula under Belladonna), or they may be made in the 
following manner : 



R. — Foliorum belladonna? . 
Foliorum hyoscyami . 
Foliorum stramonii 
Extracti opii .... 
Aqua? lauro-cerasi . . 



gr. vj (0.36). 
gr. iij (0.2). 
gr. iij (0.2). 
gr. \ (0.015). 
q. s — M. 



These various leaves are broken up like commercial tobacco, and 
moistened by adding the cherry-laurel water, which should contain 
the opium. Finally, a whole leaf soaked in the same fluid is used as 
a cover, or a piece of cigarette paper may be employed in the same 
manner. 

In some cases a very useful treatment is the smoking of nitre- 



ASTHMA. 435 

paper cigarettes, which are prepared before rolling not only by soak- 
ing the paper in a solution of nitrate of potassium (see Nitrate of 
Potassium), but also by dipping them, after drying them, in tincture 
of belladonna or stramonium, and allowing the alcohol to evaporate 
from the paper while it is hung in the air. 

A remedy very recently brought forward in this country for the 
relief and cure of asthma is euphorbia pilulifera, the fluid extract of 
which may be given in the dose of J to 1 drachm (2.0-4.0) once, twice, 
or thrice a day. (See Euphorbia Pilulifera.) 

The author finds the following formula very useful in asthma : 



R. — Sodii iodidi 

Potas. bromidi 

Ext. euphorbias piluliferse fl. 

Nitroglycerin! 

Tr. lobelia? 

Ft. in pil. vel capsul. No. i. 
S. — From 1 to 4 three times a day. 



gr. ij (0.1). 
gr. ij (0.1). 
"liij (0.15). 
gr. - 2 i„ (0.0003). 
Tryj (O.l).-M. 



It will be seen that each ingredient of this pill has a different action. 
The action of iodides in asthma is well known, as is also that of the 
bromides. The euphorbia pilulifera has been found useful in asthma 
empirically. The nitroglycerin depresses the peripheral ends of the 
vagus nerves, and acts as a stimulant to the heart when engorged with 
blood by relieving the inhibitory action of the vagus and relieving 
the blood-vessels elsewhere. The tincture of lobelia acts a depressant 
to the vagus also. 

A valuable prescription for asthmatics, particularly in those cases 
which have cardiac symptoms, is the one calling for digitalis, strophan- 
tus, and nitroglycerin in the article on Angina Pectoris. 

The use of amyl nitrite by inhalation, 3 to 6 drops (0.15-0.4) on 
a handkerchief, is invaluable in many cases, and it rarely fails to 
relieve the spasm. Owing to the engorgement of the heart consequent 
upon the embarrassment of respiration, this nitrite must be used with 
care, and in one or two instances it has proved dangerous by causing 
cardiac failure. 

Sometimes tobacco may be smoked, and it is particularly efficacious 
in those who are not accustomed to its constant use. 

Lobelia when employed should be used in full emetic dose (1 
drachm [4.0]) in the form of the tincture if an attack is present. If 
an attack is feared, 10 drops (0.65) of the tincture every four hours 
may be given if the heart is in good condition. 

A treatment of asthma which is very successful when it arises from 
nasal disorders consists in the application to the nasal cavities, at the 
onset of the attack, of the following solution by means of a brush or 
spray : 

R. — Cocain. hydrochlorat gr. xv (1.0). 

Aquae destillat. . q. s. ad i£iv (16.0)— M. 

S. — Apply as directed. 

If this solution is thoroughly applied and the other directions given 
are carried out, very rapid relief will often be obtained. Unfor- 



436 DISEASES. 

tunately, we cannot readily separate those cases which are due to 
nasal disease and those produced by other causes, and in consequence 
this treatment when tried for the first time in a given case is purely 
experimental. 

The curative treatment of asthma to a very large extent rests 
upon the use of iodide of potassium, and in the careful regulation of 
the diet and bowels, particularly if the trouble seems to be dependent 
upon indigestion. As the attacks are generally nocturnal, the even- 
ing meal should be taken early, be light and easily digested, and tea 
and coffee should be avoided at this time. The patient should avoid 
dusty streets and live in the open air as much as possible, and a damp 
atmosphere is usually preferable to a dry one, provided it is not too 
cold. This rule is subject to many variations, and each case will be 
found to be a law unto itself, and each patient must try different 
climates until the proper one is found. Arsenic may be used, par- 
ticularly if the mucous membranes are below par, and a dose of bromide 
of potassium or sodium, 30 grains (2.0) half an hour before retiring to 
bed, may be of service. Grindelia robusta is largely used as a prophy- 
lactic in the dose of 10 to 30 minims (0.65-2.0) of the fluid extract 
three times a day. 

Lobelia may also be used in the form of the tincture, 10 drops 
(0.65) three times daily. 

Compressed and rarefied air is of service, and inhalations of 
oxygen are valuable if the cyanosis is extreme. 

In many cases the greatest relief will be given by the bronchitis 
tent. (See Bronchitis.) 

In some cases the presence of nasal polypi or other irritations of 
the air-passages causes asthma to appear, and they must be removed 
before a cure can be attained. In other instances arsenical wall- 
papers are the cause of the trouble. 



BED-SORBS. 

Bed-sores depend upon disturbances of nutrition resulting from 
pressure exercised in such a manner that the local circulation is inter- 
fered with at a time when the vitality of all of the tissues is depressed 
by disease or injury. In most instances the part involved becomes 
chafed by creases in the sheets, by crumbs of food, or by moisture 
from the discharges of the rectum and bladder. 

The chief thing to be done is to prevent the trouble by careful 
nursing and cleanliness, which must be supplemented by measures 
devoted to the hardening and improving of the skin covering the 
parts where the sores are apt to appear, as over the buttocks and 
sacrum. To permit of a good supply of blood, the patient should be 
turned on one side or the other every few hours and the skin rubbed 
thoroughly with a dry towel to cause a healthy transudation and 
absorption of the nutritive juices. Salt and whiskey, 2 drachms (8.0) 
to the pint (500.0), may be rubbed over the skin, or tincture of catechu 
and the dilute solution of the subacetate of lead applied to harden it. 



BILIOUSNESS. 437 

If this is not used, a mixture of alum and spirit of camphor is useful, 
made by adding 1 ounce (32.0) of powdered alum to the whites of 4 
eggs and mixing this with 2 ounces (64.0) of the camphorated spirit. 
Where the skin is very red and angry-looking, but still intact, a 
solution of nitrate of silver of the strength of 20 grains to 1 ounce 
(1.3:32.0) is to be thoroughly painted over the spot. All these 
remedies act in hardening the skin through their astringency, or 
by acting as sedative astringents to the inflamed capillaries of the 
part. 

When a bed-sore is developed measures must be taken for its cure 
and the prevention of its spread. With this object in view the body 
must not rest on the part affected if it can possibly be avoided, and 
in order that the sore may be protected and the pressure equalized, a 
large piece of soap-plaster, with its edges deeply incised to make 
them pliable, should be applied after the sore has been thoroughly 
washed out by means of a swab or syringe filled with a 1 : 5000 solu- 
tion of bichloride of mercury, and afterward dusted with iodoform. 
Sometimes large squares of lint heavily covered with zinc ointment 
are serviceable in lieu of the soap-plaster. If the sores spread and 
burrow through the parts, the sinuses should be freely opened and 
irrigated with peroxide of hydrogen, all dead tissues being cut away 
to avoid sepsis. 

Nitrate of silver in the strength of 20 grains to 1 ounce (1.3 : 
32.0) may also be used as the patient recovers if the ulcers seem slug- 
gish, and a smooth slip-sheet should always be placed under the but- 
tocks. If possible, supportive measures and an increased amount of 
predigested food should be given if the sloughs are large. The inter- 
nal use of iron is particularly valuable in the form of the tincture 
of the chloride in full doses (say 20 drops [1.3]) every four hours. 



BILIOUSNESS. 

This is a term used to designate a state which presents different 
symptoms in different cases, but always includes languor, headache, 
or dizziness, perhaps some yellowing of the skin and conjunctiva, 
and a general sense of atony, mental depression, and discomfort. It 
depends not upon an excessive secretion of bile, but upon some per- 
version of its function or secretion or its retention in the bile-ducts. 
Further than this, most of the symptoms do not depend directly upon 
the changes in the bile, but. upon failure of proper digestion in the 
stomach and intestine, coupled with the development of irritative 
decomposition-products of various kinds. The stomach, intestine, 
liver, pancreas, and their juices all form a complex interwoven chain 
of function in which if one link breaks the entire chain becomes dis- 
turbed. The entrance into the stomach of certain food-stuffs which 
are either ill prepared or improper for gastric digestion rapidly causes 
the development of active fermentation and a splitting up of these 
bodies, with the formation of lactic and butyric acids, which irritate 
the gastric mucous membrane, and thereby bring about a faulty gas- 



438 DISEASES. 

trie secretion of mucus, which aids in making still further trouble. 
By the same means the circulation of the stomach is disturbed and 
becomes abnormal, and the intestine, liver, and pancreas receive 
reflex irritation to which they are not normally exposed. Further 
than this, the irritated stomach fails to convert its contents into pep- 
tones and the general features of chyme, and too early or too late 
drives out into the duodenum a mass of semi-digested and fermenting 
material utterly unfit for intestinal digestion and absorption, thereby 
disordering the functions of these parts still further at a time when 
they are not prepared for the reception of any food. The secretion 
poured out by the different glands varies from the normal ; the alka- 
line juices are not able to overcome the normal acid of the gastric 
juice plus the lactic and butyric acids; and finally the reaction of 
the intestine becomes acid instead of alkaline, with resulting irrita- 
tion and secretion of morbid juices and mucus. The trouble when 
existing in the stomach gives rise to headache and discomfort, a bad 
taste in the mouth, and perhaps pain, and is followed by fever, lan- 
guor, jaundice, and flatulence when the intestine is affected. The 
cause of these symptoms rests upon the fact that, while gastric juice 
and bile are antiseptic, pancreatic juice mixed with food undergoes 
rapid decomposition, with the development of products of decomposi- 
tion, such as skatol and indol and a large number of poisonous alka- 
loids. Normally, these are not allowed to form, owing to the pres- 
ence of antiseptic bile, which also hurries on the absorption of the 
food ; but if the bile is retained in its ducts, its secretion is impaired 
and its constitution altered by the disorder of the liver which results 
reflexly from the gastric and intestinal irritation. Unfortunately, 
the complication does not cease at this point, for the liver in health 
has other functions to fulfil, one of the most important of which is 
the arrest and destruction of all poisons of an organic character which 
come to it from the stomach and bowel. Not only are decomposition- 
products destroyed by it, but all the vegetable alkaloids are rendered 
innocuous if present in ordinary amounts. 1 The disorder of hepatic 
function, therefore, permits the entrance into the general circulation 
of these substances, which are very various as regards their powers 
and effects. Thus, Brunton has pointed out that one of these com- 
pounds closely resembles curare, in that it poisons the peripheral ends 
of the motor nerves, and thereby is at least partly responsible for the 
muscular relaxation and languor often seen in patients suffering from 
so-called "biliousness." Other substances act as do digitalis, atro- 
pine, muscarine, and picrotoxin, and the number of these various 
compounds is infinite. 2 

It is impossible to give space to a further consideration of these 
poisons, but what has been said shows clearly that "biliousness" 
only expresses a state in which absorption of the bile is not the sole 
cause of the symptoms, but that other poisons are at work. The 

1 See studies of Schiff, Lautenbach, and many others, including Ludwig and 
Schmidt-Mulheim. 

2 See the researches of Schweringer, Zuelzer and Sonnerseheim, Bence Jones, 
Dupre, Rorch and Fasbender, Brieger, Schmiedeberg, and Harnach. 



BJLIOUSNESS. 439 

methods of treating biliousness are therefore not to be considered as 
depending upon some regular routine, but upon a study of the case 
and its symptoms. 

Yery frequently, after several days of minor discomfort, the attack 
culminates in a severe sick headache, after which vomiting comes on 
and relief is obtained almost at once. Such patients can generally 
be relieved in the very first part of their discomfort by emetic doses 
of ipecac or apomorphine, 30 to 60 grains (2.0-4.0) of the former, or 
ji- grain (0.004) of the latter hypodermically. The manner in which 
this treatment does good is very evident. It compresses the liver and 
expels inspissated bile by the compression exercised by the abdom- 
inal walls and diaphragm in the effort of vomiting, and thoroughly 
excites to normal secretion the torpid glands of the stomach and 
intestine. 

The vomiting also rids the stomach of the fermenting masses and 
bacteria contained in them, and renders the alimentary canal pure. 
This purity may be increased between the paroxysms by draughts 
of warm water or water containing a few grains of bicarbonate of 
sodium or salicylic acid. 

When it becomes evident that an attack is about to begin — that is, 
when constipation, slight drowsiness, or languor after meals shows 
the tendencies present — one of two drugs should be used, either 
podophyllin if the stools be dark, or calomel if they be light-colored : 
jr grain (0.01) of the former to an adult is generally enough, or 1 
grain (0.05) of calomel divided into six powders, one of which is to 
be taken every fifteen minutes, is a good dose, to be followed in four 
hours by a saline. If the attack is sudden in its onset, no time is 
allowed for these hepatic stimulants, and a saline should be used in a 
good-sized dose at once, not because it causes a flow of bile, but 
because it sweeps the poisonous matters out of the gut before com- 
plete absorption can occur, and aids in restoring the normal intestinal 
alkalinity. 

The prevention of "biliousness" depends upon the maintenance 
of a normal, easily digested diet, upon the formation and excretion 
of normal bile, and the prevention of fermentation and decomposition 
in the alimentary tract. 

The term ww normal diet " is a very elastic one, and varies with each 
case. While certain forms of food are generally considered good or 
bad, easy of digestion or difficult of assimilation, it nevertheless remains 
a fact that many of the simplest foods are capable of acting as poisons. 
A large number of persons cannot take milk or eggs because their 
digestion of these substances is faulty, and the writer is cognizant of 
one case where lobster salad can be eaten at bedtime without discom- 
fort, while an egg at breakfast will cause a severe headache or pain 
in the belly. Rules as to diet must not be " iron-clad," but based on 
observation. 

By far the best means of maintaining hepatic activity in cases 
where this organ is torpid is horseback exercise, particularly if the 
exercise is taken on a trotting horse, as the jolting of the liver keeps 
the chain of digestive functions active and prevents the secretions 



440 DISEASES. 

from becoming clogged. Along with this exercise massage of the 
hypochondrium and belly-walls is useful, and the movement of stoop- 
ing over, bending from side to side, and bending backward with the 
feet close together, is of value. Coffee is often the cause of bilious- 
ness because of its oil. 

The use of pure, dark orange-colored, undiluted nitromuriatic acid 
in these cases in the dose of 3 drops three times a day in half a 
tumblerful of water is invaluable, and the fluid extract of stillingia 
in the dose of 20 drops (1.3) is of service, as is also the solid extract 
of euonymus in the dose of 3 grains (0.15). 5-grain (0.35) doses of 
extract of chirata in pill are also useful in hepatic atony of a mild 
type. 



R. — Ext. chirettee 
Podophyllin . . 
Euonymin . . 
Leptandrin . . 
Creosoti . . . 
Ft. in pil. No. xx. 
-One pill every night. 



gr. xl (3.0). 
gr. iv. (0.2). 
gr. viij (0.5). 
gr. viij (0 5). 
gr. x (0.65).— M. 



The knowledge of the action of many of the poisonous materials 
formed in the alimentary canal renders it possible for us to relieve the 
patient by other means than those which may be generally resorted to 
when the attack is present. Thus, if the pupils are dilated, the skin 
hot and dry, the eyesight dim, and the pulse rapid, the alkaloid pro- 
ducing these signs of atropine poisoning may be antagonized by opium 
in small dose, or if the pulse be slow and full, the arterial tension 
high, and there is throbbing in the head with frontal headache, the 
alkaloid representing digitalis may be antidoted by the use of aconite. 
If nervousness and irritation are present, the bromides and chloral 
may be used. 

For some unknown reason the use of caffeine in the headaches of 
biliousness nearly always makes them worse, particularly if the head- 
ache is due to over-indulgence in coffee. 

If the face is flushed, a mustard plaster or cup to the nape of the 
neck may be used, and a hot foot-bath is often of service. 

In cases where the bilious attacks are associated with catarrh of 
the stomach, intestines, or bile-dncts, chloride of ammonium, in 5- 
grain (0.3) doses, three times a day, is very useful, as is also the 
protiodide of mercury, when triturated with sugar of milk, in the 
dose of g^ to -£q of a grain (0.001-0.0015) three times a day. Fre- 
quently the use of salol or salophen in 10-grain (0.65) doses, three 
times a day, does much good in these cases, acting as an intestinal 
antiseptic. (See Salol.) 



BLEPHARITIS. 

Blepharitis is divided clinically into an ulcerative and nonulcera- 
tive variety. The indication of prime importance in the treatment 
of this affection is the removal of the scars and crusts before the 



BOILS. 441 

application of the local remedies. This may be accomplished by the 
use of alkaline solutions, bicarbonate of sodium or biborate of sodium 
(8 grains to the ounce [0.6 : 32.0]), or a 5 per cent, solution of chloral, 
as recommended by Gradle. The salves that have met with the great- 
est success are Pagenstecher's ointment (yellow oxide of mercury, 1 
grain [0.05], vaseline 1 drachm [4.0]), dilute citrine ointment, pyro- 
gallic-acid ointment, or a 3 per cent, milk-of-sulphur ointment, to 
which resorcin may be added. The latter application is useful in the 
squamous variety alone. In the ulcerated form, if the crusts are 
tenacious, these, as well as the stunted cilia, must be removed with 
forceps, and yellow-oxide-of-mercury salve or some similar application 
applied. Excellent results follow touching the crater-like abscesses 
which exist in edges of the lid with nitrate of silver. If there is 
an accompanying conjunctivitis, a boric-acid solution is suitable, 
while under any circumstances obstruction of the lachrymal duct 
— a frequent accompaniment of the disease — must be removed, and 
the nasal passages explored for any chronic inflammatory condi- 
tion. The relation between this disease and the presence of refrac- 
tive errors demands the correction of the later, should these exist, 
before a hope for cure may be entertained. 

BOILS. 

Boils are dependent upon an impoverished state of the system, due 
to several causes, or, more rarely, to some local trouble situated in the 
skin, as in the persons of oil- or paraffin-workers. 

Their constitutional treatment rests upon the use of fresh air, cod- 
liver oil, iron, arsenic, phosphate of sodium, and, if any boils are 
present at the time, the use of the sulphurate of calcium in the dose 
of -^ grain (0.006) every five hours. The sulphurate of calcium 
hastens the maturation of boils and prevents the formation of new 
ones, but is useless, according to its original user, Dr. Ringer, in the 
boils which appear during the course of some cases of diabetes. 

The local treatment of boils may be divided into the abortive and 
curative methods. The abortive method consists in painting the 
inflamed spot, when the trouble first begins, with a solution of gun- 
cotton (collodion), and renewing the coat hour after hour until a heavy 
contractile covering is formed. If pus forms under this, it may be 
absorbed, but if this does not occur, then the boil must be opened 
under antiseptic precautions and properly dressed. A strong solution 
of nitrate of silver is also very useful at the very beginning of the 
formation of a boil if painted over the part in the strength of 20 
grains to the ounce (1.3 : 32.0). The other local applications consist 
in the use of the extract of opium or belladonna over the part to 
relieve pain and decrease the inflammation. 

Poultices may also be used to relieve the sensation of tenseness 
and mature the boil, and should contain sweet oil and laudanum. 
Ringer recommends the application of alcohol and camphor over the 
skin in the early stages. After the skin is Aviped dry it is to be 
smeared with camphorated oil. Stelwagon uses the following : 



442 DISEASES. 

R.— Ichthyol 3J (4.0). 

Emplast. plumbi 31J (8.0). 

Emplast. resinse ^ij (8.0).— M. 

S. — Apply to th© part. 

He also approves of the injection of a few minims of a 5 per cent, 
solution of carbolic acid into the apex of the boil if its formation is 
assured. 

BREASTS (INFLAMED). 

Mastitis is, from a medical point of view, readily treated. Lacta- 
tion should at once cease, and the breast be dressed by the use of a 
sponge compress, underneath which belladonna ointment is to be copi- 
ously smeared. Belladonna is a useful remedy both before and after 
very acute inflammation has begun, and its use should be persisted in 
for twenty-four hours. 

At the same time that these measures are resorted to, the circula- 
tion should be thoroughly impressed by aconite or veratrum viride, 
and mild saline purges should be given. If the milk persists in form- 
ing, it must be removed by the breast-pump. For the surgical treat- 
ment of mastitis the reader should refer to books on surgery. 

BRIGHT'S DISEASE (ACUTE). 

The treatment of acute nephritis accompanied by any active 
inflammatory change requires care and intelligence. The pain in 
the loins, and perhaps the bloody urine, which is scanty and high- 
colored, febrile disturbance, and the history of exposure or other 
exciting cause, all form a clinical history typical in its major points. 
Here, as elsewhere, for the reduction of inflammation circulatory 
depressants are to be resorted to, and aconite is generally most ser- 
viceable. The patient should be kept quietly in bed and supplied with 
a milk diet, cups or leeches being used over the loins if the urine is 
scanty. Blisters are not advisable, as the irritant substances pro- 
ducing them may be absorbed and cause increased renal irritation. 
The restlessness will generally be quieted by the aconite ; but if this 
fails, resort must be had to bromides or small doses of opium, which 
must be given cautiously, as these drugs are not readily eliminated 
when the kidneys are diseased. Cannabis indica is thought to be of 
great service if bloody urine is present, but chloral is generally too 
irritating to the kidney to justify its employment. The appearance 
of large amounts of blood in the urine at about the fifth day of the 
illness is an indication, according to Sydney Ringer, for the use of 
drop doses of tincture of cantharides, given every few hours. Should 
the urine be scanty and of high specific gravity, and constipation be 
present, a purgative dose (^ an ounce [16.0]) of sulphate of mag- 
nesium should be used to aid in the elimination of impurities by the 
bowel. Warm mucilaginous drinks, as flaxseed tea, are of service, 
and the use of the citrate of potassium and the sweet spirit of nitre 
with copious draughts of pure water should be resorted to to increase 
urinary flow. 



BRIGHT'S DISEASE. 443 

If dropsy or symptoms of uraemia come on, they must be relieved 
by the use of hydragogue purges, such as elaterium, which is partic- 
ularly useful in that it is supposed to aid in the elimination of the 
urea by the bowel. Jaborandi or pilocarpine may be used to sweat 
the patient at this time or in the earlier stages with advantage ; |- 
grain (0.008) of the hydrochlorate should be given hypodermically, and 
repeated in fifteen minutes if no sweat appears ; but it should never 
be forgotten that when the heart is feeble or the patient very sus- 
ceptible pilocarpine may produce serious collapse. This can generally 
be guarded against by the use of strychnine in -J^-grain (0-003) doses. 
Hot-air baths are often useful to provoke a sweat. (See Heat, in Part 
III.) Generally these cases go on to recovery, although convalescence 
is often somewhat prolonged. The treatment of the later stages con- 
sists in the use of stimulants to the kidneys to arouse them from the 
atony consequent upon the excitement of inflammation. To this end 
digitalis and squill, or digitalis and calomel, or caffeine citrate, may 
be used in small amounts, gradually increased and followed by the 
compound spirit of juniper or gin as the case progresses. If the 
renal structure is persistently atonic, \ to 1 drop (0.01-0.05) of the 
tincture of cantharides at each dose may be used, and, as anaemia is 
often a prominent symptom, tincture of the chloride of iron, which 
is both a diuretic and a tonic, should be resorted to. If renal hemor- 
rhage is excessive, gallic acid and ergot are indicated to control the 
bleeding. A milk diet should be rigidly enforced. (See Uraemia.) 



BRIGHT'S DISEASE (CHRONIC). 

The treatment of chronic nephritis is a very different matter, so 
far as prognosis is concerned, from that of the acute form. It is 
almost, if not quite, impossible to cure the condition present, and we 
can only improve the state of the kidneys and other organs by care 
and the use of proper drugs. As Tyson has aptly put it, we must 
try to arrest the development of the renal lesions and improve the 
general health, treat the symptoms which are not dependent upon the 
nephritis, except indirectly, and, last, treat those signs which are due 
to the nephritis itself. To arrest the disease all alcoholic drinks 
should be avoided as far as possible, and business cares and worries 
be cast aside. Great care should be taken to avoid cold, and a warm 
climate is generally to be recommended to the patient, since sudden 
changes of temperature tend to produce congestion of the kidneys by 
the chilling of the skin. 

The diet and drink are important considerations, and should con- 
sist largely of milk. Many physicians direct that skimmed milk be 
used. The author believes that this advice is not wise, as it deprives 
the patient of the nutritive fats, which he needs and which are not 
contraindicated, whereas the proteids of skimmed milk, while the 
best form of albuminoid food we can give, are not advantageous, but 
have to be used to maintain nutrition. If the cream in the milk dis- 
agrees with the patient, it may be removed in part or diluted by the 



444 DISEASES. 

addition of water. Beyond this we can do little toward a cure. To 
allay symptoms we can do much, and the albuminuria can be great! v 
decreased by the use of digitalis, squill, the acetate and bitartrate of 
potassium, and the iodides ; nor should the bichloride and protiodide 
of mercury be forgotten, as they are very valuable indeed. These rem- 
edies are also of value to relieve the dropsy, and the most efficacious 
treatment of all is a combination of the bitartrate of potassium and 
juniper-berries, so that 1 ounce (32.0) of the former is dissolved in 
1 pint (500 cc.) of an infusion of the latter and taken in twenty-four 
hours. A most valuable aid in decreasing the albuminuria is the use 
of 1 to 3 drops of tincture of cantharides in water three times a day, 
particularly if the kidney seems torpid and is secreting too little 
urine. If dropsy develops, hydragogue purges are useful, such as 
jalap and elaterium, and hot baths, Turkish or Russian, are to be 
given, not only to relieve the dropsy, but to so hypertrophy the excre- 
tory glands of the skin that they will be able through greater activity 
to relieve the kidneys. (See Heat.) Sugar of milk may be given in 
the dose of 40 to 80 grains (2.65-5.5) a day as a diuretic, and butter- 
milk is a useful form of food. (See Sugar of Milk.) 

Ascites or thoracic effusions should be treated by tapping. 

In the chronic interstitial forms of this disease Bartholow has 
highly recommended the use of the chloride of gold and sodium in 
the dose of -fa to y 1 ^ grain (0,003-0.006). The anaemia is to be com- 
bated by the use of the tincture of the chloride of iron, or Basham's 
Mixture (see Iron), and oxygen inhalations. 

The arsenite of sodium and the carbonate or citrate of lithium are 
also said to be of value in chronic contracted kidney, particularly if 
it is dependent upon a gouty taint. The dose of the former should 
be 2V grain (0.003), and of the latter 5 grains (0.35), three times a 



BRONCHITIS (ACUTE). 

In the early stages of bronchitis there is always present a very 
distinct hyperemia, followed by a true inflammation of the mucous 
membrane lining the bronchial tubes. When these changes are con- 
fined to the larger bronchi, the term " bronchitis " is employed, but 
when the minute bronchioles are invaded, the disease is known as 
"capillary bronchitis." In the article on Pneumonia and elsewhere 
in this book the writer has spoken of the various stages of inflamma- 
tion, the measures indicated under such circumstances, and has de- 
scribed the action of the various drugs. In many cases the phy- 
sician only sees the patient when the second stage of his disease is 
present, but if the individual presents himself at once, the following 
history and physical signs will indicate the treatment to be employed: 
After exposure, more or less severe, to wet, dampness, or dry cold, a 
sensation of oppression comes on, associated with a feeling of " tight- 
ness across the chest " or a sensation as if a bolus of food was under 
the sternum. Aching and pain may then be traced over the lines of 
the bronchial tubes, while the dry hacking cough increases the dis- 



BRONCHITIS. 445 

comfort and seems to strain the tubes till each one can be outlined on 
the chest-wall by the patient. The cough, when it occurs, is vir- 
tually unproductive, and often hurts the larynx and throat. On mak- 
ing a physical examination by auscultation there will be found over 
the posterior aspect of the chest, between the shoulder-blades, sounds 
of bronchial breathing, which are rougher than normal, and due to 
the air passing over an inflamed, swollen, and roughened mucous 
membrane. This bronchial roughening may be sufficient to cause 
a harsh respiratory sound over the entire chest, and the expiratory 
sounds may be heard a little louder than usual. No other changes 
from the normal can be noted, but isolated spots of discomfort may 
be pointed out by the patient where aches, " catches," or "kinks" 
seem to be present in a previously normal tube. Percussion, palpa- 
tion, and inspection show nothing more of note. 

Some fever may be present. 

If possible, the patient is to be put to bed. If he be strong and 
hearty and if the signs of inflammation are severe enough to cause 
alarm, a full dose of pilocarpine may be ordered for the production 
of a sweat, particularly if there is a great necessity for rapid cure 
without regard to the nausea which may be produced by the drug. 
If this is done, no other medicine need be used, but the employment 
of a mustard foot-bath and a drink of hot brandy or whiskey and 
water should be ordered. 

In the majority of cases, however, this treatment is not called for, 
as it is unnecessarily severe, and the pilocarpine should be replaced by 
full doses (2 to 4 drops [0.1-0.2]) of the tincture of veratrum viride or 
a teaspoonful of the wine of antimony in adults, or J to 1 drop (0.025- 
0.05) of the tincture of aconite in children, the employment of hot 
drinks and a foot-bath being also insisted upon. Generally it is well 
to combine with the aconite some sweet spirit of nitre, as follows : 

R.— Tinct. aconit Tr^viij (0.6). 

Spt. aether, nitros f^ij (8.0). 

Aquae q. s. ad f zj (32.0).— M. 

S. — A teaspoonful (4.0) to a child or a dessertspoonful (8.0) to an adult. in water every 
hour. 

In many adults 5 to 10 grains (0.30-0.65) of Dover's powder with a 
hot drink is better. 

If the attack is not aborted, while the first stage is still present, 
before secretion is established, resort should be had to ipecac and to 
citrate or acetate of potassium, which act as sedatives to the inflamed 
mucous membranes and aid in the formation of secretion, moistening the 
inflamed surfaces and thereby overcoming the dryness and irritation. 
The potassium salts also act as febrifuges, and should be used in full 
doses, as much as 40 grains to 1 drachm (2.6-4.0) in a day, in addi- 
tion to the aconite already recommended. The following prescription 
illustrates their employment : 

R. — Syrup i ipecac f^j vel fgiij (4.0-12.0). 

Potassii citratis ,^iv (16.0). 

Aquae destillat q. s. ad f^yj (192.0).— M. 

S. — Dessertspoonful (8.0) every four hours for a child of five years. 



446 DISEASES. 

Or, 

R. — Syrupi ipecac , . . f^ij (64.0). 

Succi limonis fjj (32.0). 

Potassii carbonatis giv (16.0). 

Spirit, aether, nitrosi f,%j (32.0). 

Aquae destillat q.s. ad f^vj (192.0). — M. 

S. — Dessertspoonful (8.0) every four hours for an adult. This mixture should not be 
corked for some time after it is made. 

For a child this prescription should be reduced just one half in 
each part with the exception of the water. 

In some cases, particularly if the patient be a child, large doses 
of the citrate or other salt of potassium exert a depressing influence 
and have to be decreased. 

The use of antimony as a remedy in the early stages of bronchitis 
should only be resorted to when a very powerful action is required 
and the individual is very strong and sthenic. Under these circum- 
stances it may be given in full-enough dose to produce marked nausea, 
and even vomiting, with a profuse sweat. Along with the depression 
a profuse outpouring of liquid takes place in the bronchial tubes, 
which speedily relieves their congestion, and in consequence brings 
on the second stage of the disease in an hour or two instead of in two 
or three days. Unless some pressing need requires it, most persons 
will regard this remedy as worse than the disease. 

Counter-irritation may be applied to the chest in the shape of a 
mustard or spice plaster, or dry cups may be employed, several on 
each side of the vertebral column at about the sixth rib. If the sore- 
ness of the bronchial tubes is not relieved by this means, inhalations 
of steam arising from boiling water placed before the patient may be 
practised, either through a cone, one end of which covers the top of a 
pitcher and the other end of which covers the mouth and nose of the 
patient, or by covering the head and pitcher with a towel. The use- 
fulness of this method may be much increased by the addition of 1 
tablespoonful of compound tincture of benzoin to each pint of water. 

When fever is persistent quinine should be used, in addition to the 
aconite already recommended, and if the cough is excessive and annoy- 
ing, 2V to y 1 ^ grain (0.003-0.005) of morphine may be given to an 
adult in each dose of the solution just named, or a few drops of the 
spirit of chloroform may be added to the prescription. 

In children and in adults, both in the first stage of bronchitis and 
in the later stages, the use of the so-called "bronchitis tent" is of great 
value. It consists of a canopy raised over the bed a sufficient distance 
to allow of the circulation of plenty of air. Through one side of this 
canopy passes a tube leading from a tin pail or kettle of boiling water, 
under which is an alcohol lamp to keep the temperature of the water 
sufficiently high. By this means the air breathed by the patient is so 
saturated with moisture that the mucous membrane lining the air- 
passages is soothed and quieted. In order that the full benefit of 
this measure be understood, it must be remembered that a mucous 
membrane in the early stages of inflammation is always dry and red, 
lacking its normal moisture, and that the upper air-passages fail to 
catch upon their surfaces, by reason of their dryness, particles of dust, 



BRONCHITIS. 447 

and do not moisten the air before it reaches the lungs. Again, it will 
be remembered that the bronchial mucous membrane is covered with 
ciliated epithelium, which, by the constant upward wavy motion of its 
cilia, urges out of the lung all impurities. Dryness of the surface 
at once stops this ciliated movement, with unfavorable results. The 
employment of the "bronchitis tent " is equally useful in adults, but 
less readily employed, owing to the size of the bed. 

Having considered the treatment of the first stage of bronchitis, 
we pass to that of the second. The condition of the mucous mem- 
branes is now quite different from that which Ave have just been 
speaking of. In the place of an absolute lack of secretion we have 
a profusion of cast-off epithelial cells, a large amount of mucus, and 
more or less liquid poured out upon the walls of the bronchial tubes, 
forming obstructions everywhere to the ready passage of air. The 
secretion is apt to be more or less viscid, ropy, and, when it is coughed 
up after considerable effort, appears in lumps, particularly in the 
morning. This state is one in which the excitement of inflammation 
is followed by local depression and an effort on the part of the tissues 
to rid themselves of the congestion and of the useless epithelial forma- 
tions. The physical signs on listening to the chest are now found to 
consist in a large number of loose rales which are distinctly wet and 
moist. Later they become markedly liquid and bubbling, and so large 
as to cause gurgling on inspiration and expiration. Sometimes they 
are musical or squeaking. Generally the latter signs do not come 
on until the case is far advanced, and, if a cure is soon to be reached, 
they only last a few days or hours, as the mucus is so loose as to be 
easily coughed up and the lung readily cleared. 

The object of the physician is to use remedies which will stim- 
ulate the bronchial tubes and increase the volume of liquid poured 
out. For this purpose the bronchitis tent may of course be employed, 
but the drugs to be used internally are ammonium, chiefly the chlo- 
ride, and the pitches and turpentines, such as terebene, pyridine, 1 or 
even turpentine itself. Allium or garlic is often of great service at 
this time or a little later in the course of the ailment. It may be 
used by boiling garlic in milk or by the application of an onion or 
garlic poultice, or by the use internally of a teaspoonful of syrup of 
garlic four times a day. 

In the majority of instances an ammonium mixture will be the 
best and most serviceable prescription, in one of the following forms : 

R. — Ammonii chloridi £ij (8.0). 

Ext. glvcvrrhiz. fluid £ij (8.0). 

Aquse destillat q. s. ad f^iij (96.0).— M. 

S. — Teaspoonful (4.0) every four hours. 



Or, 



R. — Ammonii chloridi ^ij (8.0). 

Mist, glycyrrhiz. comp. ....... fjfiij (96.0). — M. 

S. — The same dose. 



1 Pyridine, not pyrodine, is used by placing 1 fluidrachm (4.0) on a hot shovel or 
saucepan in a small room, the patient breathing the fumes, which are carried to him 
by the air of the apartment. 



448 DISEASES. 

The disadvantage of the latter prescription is the presence of anti- 
mony in the compound liquorice mixture, which is contraindicated if 
debility exists. 

If the cough is troublesome, a little morphine or belladonna may 
be added, or the following be used, particularly if any signs of car- 
diac failure appear : 

R. — Ammonii chloridi . . 3J (4.0). 

Ammonii carbonatis 3J (4-0). 

Ammonii bromidi 3J (4.0). 

Extract, glycyrrhiz. fluid giv (16.0). 

Aqua? destillat fgvj (192.0).— M. 

S. — Dessertspoonful (8.0) every four hours. 

In this prescription the first constituent acts particularly on the 
air-passages, the second stimulates the heart and respiration, and the 
third allays the cough, while the liquorice covers the salty taste of the 
ammonium. 

R.— Codein gr. ij vel iv (0.-0.2). 

Amnion, chlorid 3j (4.0). 

Ext. glycyrrhiz. fl f|j (82.0). 

Aquae q. s. ad f§ij (64.0). — M. 

S. — Teaspoonful (4.0) every two hours in water. 

Ammonium chloride may be also used by means of the steam 
atomizer or by inhalation of its fumes by the use of some of the 
apparatus used for this purpose. In obstinate cases the inhala- 
tions of the fumes from chloride of ammonium may be very necessary. 
These may be obtained by attaching a long piece of rubber tubing to 
one end of a glass tube about one and a half inches in diameter, and 
placing in the centre of this tube a drachm or two of sal ammoniac, 
the tube being placed in a horizontal position, each end resting on a 
thick book or other support. The open end of the glass tube is 
lightly packed with cotton, and a small alcohol lamp passed backward 
and forward under the tube where the ammonium salt is lying. The 
patient may now gently inhale through the rubber tubing, and take 
the fumes which are set free directly into the air-passages. 

A very simple and ready way of using this salt without apparatus 
is to place a few grains of it in an iron spoon and heat the drug over 
a gas-jet, the fames being inhaled when the spoon becomes well 
heated. (See article on Ammonium Chloride.) 

An oro-nasal respirator, with the sponge saturated with equal 
parts of terebene, iodide of ethyl, and chloroform, may be worn in 
order to allay cough and loosen the mucus. 

Counter-irritation may do good at this stage, particularly if 
applied over some aching bronchus, and a blister or plaster may be 
employed, or even a dry cup resorted to. 

If the administration of the chloride of ammonium does not aid in 
the expulsion and liquefaction of the secretion and rid the lungs rap- 
idly of the mucus, the use of terebene in 5- or 10-minim (0.35-0.65) 
capsules may be resorted to with great success. If capsules cannot be 
supplied, terebene may be made into an emulsion with acacia or trag- 



BRONCHITIS. 449 

acanth and given in this way. Sometimes terebene will irritate the 
kidneys and produce a sense of weight across the loins ; if this occurs 
its use should be stopped. In other cases it will disorder the stomach 
or cause diarrhoea. These effects are not, however, commonly seen. 
Terpine hydrate in 10-grain (0.65) doses may be used three times a 
day, or terpinol in the close of 8 to 10 grains (0.5-0.65) in capsules 
or pills. Certain of the volatile oils and resins are also of value at this 
time, notably the oleoresin of cubebs and copaiba, which, however, pos- 
sess the disadvantage of disordering the stomach. The oil of eucalyp- 
tus is also of great value, and may be given in capsule or emulsion in 
the dose of from 1 to 5 drops (0.05-0.35) every five hours. The oil of 
sandalwood in the dose of 5 to 10 minims (0.35-0.65) is very valuable, 
and is not so apt to disorder the stomach, bowels, and kidneys as are 
some of the other remedies named. The balsams of Peru and Tolu 
may be used, but ought always to be combined with other more active 
drugs. 

Apomorphine has been highly recommended in the subacute 
stage of bronchitis as an expectorant for the purpose of loosening the 
phlegm and increasing secretion. The dose should be from -^ to -^ 
grain (0.003-0.006) by the mouth to an adult, three times a day, 
under such circumstances. Squill has had a very good reputation in 
this stage of bronchitis, but is a very poor remedy as compared to 
most of those now in use, irritating the stomach and kidneys and 
acting comparatively slightly on the diseased area. 

While the proper use of these remedies usually brings about the 
results desired, in others a stage of profuse secretion comes on which 
in its treatment is identical with that seen in chronic bronchitis, 
chronic " winter cough," and emphysema, so these diseases will 
therefore be considered together. 

In old persons suffering from dilated bronchial tubes, from emphy- 
sema, and from chronic bronchitis there is constantly poured into the 
air-passages so free a secretion that persistent coughing is necessary to 
rid the lung of enough of the mucus and liquid to enable the man to 
breathe. Any excess of this exudation drowns him in his own secre- 
tions, and the constant obstruction to the ready flow of air and blood 
in the lung soon produces dilatation and weakness of the right side 
of the heart. The same condition in a more acute form sometimes 
asserts itself in young children and in adults. In children it some- 
times comes on so suddenly as to be known as " acute suffocative 
catarrh," while in older persons it appears with sufficient severity to 
make the condition of the patient most serious. Of the treatment of 
the latter state the writer will speak at once. 

The objects desired are to rid the lung of the liquid secretions, to 
prevent the outpouring of more exudations, and to support the patient 
until the crisis is past. Where the exudations rapidly fill the lung, 
nothing is better in the strong child or adult than an active emetic, 
such as apomorphine, hypodermically, in the dose of y 1 -^ grain (0.006) 
to an adult or -^ to a child, which is not to be repeated ; if this dose 
fails to act in ten minutes, ipecac may be used instead in the form of 
the powder, a small teaspoonful for a man or 5 to 10 grains (0.35- 

29 



450 DISEASES. 

0.65) for a child, or, if the powder be not at hand, a wineglassful (32.0) 
of the wine or syrup of ipecac to an adult or two teaspoonfuls (8.0) to a 
child may be given. Digitalis should be administered to support the 
heart, and strychnine be employed in full dose to stimulate the respira- 
tory centre and excite the nervous system, which is generally depressed 
by the increasing carbonic acid in the blood. For the same purpose 
caffeine or strong coffee may be used. Oxygen may be inhaled, and 
to stop the profuse secretion atropine may be used by the mouth or hypo- 
dermically. If death seems at hand, hot and cold dashes of water may 
revive the patient sufficiently to keep up respiratory movements until 
voluntary efforts are made once more by the patient. The alternate 
use of hot and cold water is necessary for the exaggeration of periph- 
eral sensation, and the hot water aids in preserving the bodily tem- 
perature. Sometimes letting the patient hang his head over the bed 
when he coughs may aid in the expulsion of the liquid. 

The treatment of the more moderate condition of excessive secre- 
tion in the bronchitis of old persons, which is more slow in its prog- 
ress, but which may end as fatally as similar attacks in the young, 
is somewhat similar to that just given. Injurious results are often 
produced by the physician failing to recognize that the secretion is suf- 
ficiently liquid, and that ammonium and such expectorants are not 
only useless, but harmful, because they increase the quantity of these 
liquids. Under these circumstances a fine spray of a solution of tan- 
nic acid of the strength of from 2 to 30 grains (0.1-2.0) to the ounce 
may be used, or of alum solution from a few grains to saturation. 
Monsel's solution should be employed in the dose of 10 to 15 drops 
(0.65-1.0) to the ounce (32.0) of water, or acetate of lead may be used 
in the strength of from 1 to 15 grains to the ounce (0.05-1.0 : 32.0). 
Lobelia induces a too free secretion, and is contraindicated under 
such circumstances. The use of opium to check the excessive excre- 
tion is a measure of doubtful value, as it checks the cough, and thus 
causes the lung to become more rapidly filled with mucus. Bella- 
donna, which checks secretion even more than opium, stimulates the 
respiratory centre, and is for this reason a doubly useful remedy. 
Counter-irritation may do good, and if the patient be strong free 
purgation should be resorted to. Strychnine is, however, the best 
of all remedies to help the patient to get rid of the sputum. It should 
be given in the dose of ^V g ra 'in (0.006) or more three times a day. 

In those cases where dilatation of the tubes is present in old per- 
sons, Calabar bean, in the form of the tincture (4 to 8 drops) or extract 
of physostigma, is of service, owing to its action as a tonic on the 
muscular fibres of the walls of the tubes, preventing further bronchial 
dilatation and aiding in the expulsion of the secretion as rapidly as 
it is formed. 

The use of remedies designed to allay the cough in these cases is 
absolutely unjustifiable, as it results in the retention of the profuse 
secretion. The question as to whether the cough is excessive or not 
must depend on the ability of the lung to rid itself of the secretions 
in its bronchial tubes. 



DUBNS AND SCALDS. 451 



BURNS AND SCALDS. 



The treatment of burns and scalds is both internal and external, 
the first being devoted to the quieting of the nervous system after the 
injury, the relief of pain, and the treatment of shock, and the second 
to the care of the injured surfaces. Immediately upon being called 
to a case of burn it is the duty of the physician to determine how 
badly shocked the patient is, what the condition of the pulse may be, 
and whether or not the lungs and air-passages are involved. After 
these mental notes he should give a hypodermic injection of \ to \ 
grain (0.016-0.03) of morphine and -^ of atropine (0.001), and then 
roll the entire body in a large quilt to maintain the bodily heat while 
the sufferer is being transferred to the hospital or the house to which 
he belongs. 

In some cases the shock is so great that the pulse flags at once, the 
temperature falls, and collapse ensues. Stimulants hypodermically, 
external heat, and warm drinks of water and whiskey are indicated, 
followed by -^ grain (0.003) of strychnine and 5 minims (0.3) of 
tincture of digitalis if the circulation does not respond to the less 
powerful stimulants. 

If time and circumstances permit, the dressings should be applied 
before moving the patient, but this is rarely possible. By far the 
best dressing is lint wrung out of a mixture of linseed oil and lime- 
water, equal parts, or, if desired, the oil may be rendered antiseptic 
by the addition thereto of 1 part of carbolic acid to 20 parts of oil. 
This mixture is also of service in that it acts as a feeble local anaes- 
thetic. The cloths should be renewed every twelve or twenty-four 
hours, as may be needed, or they may be substituted by lint wrung 
out of a saturated watery solution of boric acid. 

If the burn is not very diffuse, a solution of the tincture of can- 
tharides, 1 part to 40, upon a rag, is said to relieve pain and aid in 
healing, but if the burned surface be extensive this treatment cannot 
be resorted to, owing to possible irritation of the kidneys, which are 
already overtaxed by the interference with the functions of the skin. 
In comparatively small burns a saturated solution of carbonate of 
sodium (washing soda) often does great good in relieving the pain. 
This relief may depend on the solvent power of this salt over albu- 
minous deposits, formed by the heat, which irritate the peripheral 
nerves. 

A large number of other remedies have been and can be used, but 
are no better than those named, and less generally employed. 

A very important point in the subsequent treatment of burns is 
the remembrance of the close relationship existing between the internal 
organs, particularly the duodenum and the kidneys, and the cuticle. 
When we recollect that we try to influence internal congestions — such 
as pulmonary congestion — for example — by the application of irrita- 
tion to the skin of the chest, we see at once that a widespread and 
severe burn is practically a huge counter-irritant and must reflexly 
affect the viscera. 

Again, the skin, being prevented from exhaling impurities, forces 



452 DISEASES. 

the kidneys to do the work, and if the kidneys fail under the strain 
death results. Whenever the urine is high-colored and cloudy the 
citrate of potassium should be freely given, 20 grains (1.3) in water 
three times a day, combined with 30 drops (2.0) of sweet spirit of nitre, 
care being taken that the depressant effect of the potassium is counter- 
balanced by stimulants. 



CHANCROID. 

The chancroid is a contagious, non-specific ulcer, which has no 
period of incubation, is distinctly inflammatory in type, and is usually 
multiple. It is further distinguished from the primary sore of syph- 
ilis by the fact that it is auto-inoculable, is not followed by secondary 
eruptions, and, if it involves the lymphatics at all, produces a mono- 
ganglionic unilateral swelling which frequently attains a considerable 
size and suppurates. 

Chancroid, being a purely local affection, would seem to require 
nothing beyond local treatment: this is true of the uncomplicated sore, 
but where phagedena or serpiginous ulceration sets in, the question 
of constitutional treatment is of paramount importance. 

The treatment of uncomplicated chancroid is as simple as it is 
efficient. One thorough cauterization converts the sore into a healthy 
ulcer, the cicatrization of which is quickly and surely accomplished. 

As the most efficient means of thoroughly destroying the chancroidal 
ulcerations the actual cautery is chiefly commended. This is, how- 
ever, objectionable to patients. Sulphuric or nitric acid will be found 
equally serviceable. The pain of these applications may be greatly 
lessened by the previous employment of a 20 per cent, solution of 
cocaine. When the surface involved is large the patient should be 
etherized. The cardinal point in the cauterization of chancoids is to 
reach and destroy all the diseased area. Each pocket and sinus must 
be thoroughly acted upon, otherwise it remains as a focus for reinfec- 
tion. A convenient way of both destroying the chancroid and pro- 
viding for the after-dressing is offered in the application of Ricord's 
paste. This is made by adding to finely powdered charcoal enough 
strong sulphuric acid to form a paste of about the consistency of 
castor oil. This is then applied to every portion of the ulcer. The 
acid shortly dries out, leaving a dressing of charcoal, which in a few 
days drops off, exposing a healthy, nearly healed, granulated surface. 
Where nitric acid is applied the subsequent dressing consists, pre- 
ferably, in the application of dusting powders, iodoform being the 
best. 

There has been a tendency of late years to substitute for this treat- 
ment one less radical, more acceptable to the patient, and in many 
cases almost equally satisfactory in results. It is certainly true that 
many of the chancroids as found in persons of robust health show 
little tendency to spread beyond comparatively narrow limits, and are 
amenable to mild treatment. It must be remembered, however, that, 
as long as the smallest portion of such an ulcer remains unhealed it 



CHANCROID. 453 

may at any time take on all the features of a virulent ulceration. 
Moreover, the patient is constantly exposed to the risks of a chan- 
croidal bubo — a complication so troublesome that the possibility of 
its development constitutes the strongest argument against palliative 
treatment. 

Where the ulceration is entirely superficial, constituting the erosive 
form of chancroid, iodoform, dusted over the surface of the carefully 
cleansed granulations, offers the best form of palliative treatment. 
As a cleansing and stimulating wash to precede the application of the 
iodoform 1 drachm (4.0) of nitric acid to the pint (500 cc.) of water 
is most satisfactory. The objection to iodoform lies in its disagree- 
able and penetrating odor. To prevent this, great care should be 
exercised in applying the powder to see that none is distributed else- 
where than upon the sore. The odor can also be disguised to some 
extent by thoroughly mixing with the iodoform a small quantity of 
one of the essential oils, such as oil of peppermint or attar of roses, 
using not over 5 minims (0.35) to 1 drachm (4.0) of the powder. 
There is no dusting powder which can entirely take the place of 
iodoform, yet when the objections to the use of the latter are insu- 
perable aristol or iodol may be substituted, or a mixture of 1 drachm 
(4.0) of zinc oxide and 3 drachms (12,0) of subnitrate of bismuth, or 
equal parts of calomel and bismuth. Where the discharge is profuse, 
powdered tannin may be combined with the dusting powder in the 
proportion of 1 part to 4. 

In the ordinary uncomplicated chancroid these dry dressings are 
greatly to be preferred to wet applications : when, however, the sore 
is attacked by a high grade of inflammation and becomes indurated, 
prolonged immersion of the part involved or of the whole body in hot 
water may be followed by the application of dressings kept constantly 
wet with the dilute nitric-acid lotion, as given above, or with weak 
carbolic solution, 5 grains to the ounce (0.35 : 32.0) of water, or with 
lead-water and laudanum. Where the chancroid assumes the phagedenic 
type, extending with great rapidity and causing extensive sloughing 
and destruction of tissue, free cauterization either with the hot iron 
or by means of nitric acid should be instituted immediately, every 
portion of the ulcerating surface being thoroughly destroyed. This 
should be followed by prolonged hot sitz-baths or general warm baths, 
the patient remaining in the water for days at a time if necessary, 
and, if practicable, eating and sleeping with the body still immersed. 
If this is not possible, baths of from two to four hours' duration 
should be given two or three times daily. After cauterization, pow- 
dered iodoform is the best local application in phagedenic cases. In 
addition the patient may be given full doses of opium, and should 
receive a tonic and supporting treatment. 

Should the chancroid assume the serpiginous type, slowly extend- 
ing in spite of treatment, till in the course of months or }^ears large 
areas are destroyed by the process, the warm bath, continued night 
and day for weeks at a time, together with thorough cauterization of 
the entire diseased surface with the hot iron, represents the most 
satisfactory method of treatment. 



454 DISEASES. 

The chancroidal bubo is best avoided by prompt and thorough 
cauterization of the sore : when it occurs, however, it should be first 
treated by rest, pressure, and counter-irritation, since it may be a 
simple inflammatory adenitis, and with care may not run on to sup- 
puration. Iodine may be painted around the swollen area, the patient 
should be put to bed, and a compress, together with a spica bandage 
of the groin, should be applied, or this may be substituted by a hot 
bag placed upon the inflamed gland. At the first sign of suppura- 
tion the bubo should be opened freely, should be washed out with 
bichloride solution, 1 : 1000, peroxide of hydrogen half strength, or 
chloride of zinc 40 grains to the ounce (2.65 : 32.0) of water, and 
should be packed with iodoform gauze. If the bubo takes on phag- 
edenic action, it should be treated precisely as the phagedenic chan- 
croid. 

CHOLERA, ASIATIC. 

The treatment of this exceedingly dangerous disease is prophy- 
lactic, curative, and convalescent. 

The first measures consist of strict quarantine, both public and 
private, the avoidance of all water for culinary purposes which has 
not been boiled at least an hour and cooled in a place devoid of 
germs, and the employment of those foods which, while preserving 
the normal bodily health, in no way predispose to intestinal dis- 
turbances, as do some of the fruits, as melons and grapes. If these 
things are attended to, little remains to be done ; but it is worthy of 
remark that sulphuric acid is a drug which is harmless in itself, yet 
apparently one which is possessed of distinct prophylactic power in 
this disease. 

Dividing the disease into three stages, we find as the earliest symp- 
tom some disturbance of peristaltic movement, with or without pain, 
or in other instances the patient is attacked with a sudden flux of the 
intestinal contents. If there is a history of the ingestion of bad or 
indigestible food, there is no doubt whatever that this foreign material 
must be gotten rid of by the use of castor oil or sulphate of magnesium, 
the latter being the best, because it is more rapid and less apt to 
cause griping. No purgative should be given unless the history of 
the ingestion of bad food is most direct and clear. 

When the attack is sudden in its onset, as is usual, the question 
arises, Shall we resort to opium by the mouth ? The answer, after 
having carefully considered the statements of a large number of 
authors, is that we should not use opium by the mouth or hypo- 
dermically except in cases where the pain or cramps are so excessive 
as to absolutely require the drug. In other words, it is to be given 
for the pain, not for the diarrhoea. Should opium be used, it is 
infinitely better to employ it by the rectum in the manner to be 
described later, and if it is necessary to . use it by the mouth, only 
the deodorized opium or the deodorized laudanum should be em- 
ployed, since these preparations are less apt to cause nausea than 
their fellows. 

Any one who has seen the nausea and depression following the use 



CHOLERA ASIATIC. 455 

of full closes of opium in those who are susceptible to it will be strongly 
impressed with this fact ; and in America, at least, adults of the better 
class, as well as children of all classes, are often so seriously depressed 
by full doses of opium as to be on the verge of collapse. Not only 
would the onset of such symptoms seriously complicate like symptoms 
caused by the disease, but there seems to be no doubt that the use of 
the drug so seriously perverts the functions of the stomach as to 
make the entrance of germs comparatively easy. Recent researches 
in regard to the bacillus of Koch show that an acid medium is unfa- 
vorable to its existence, and other researches have proved that opium 
seriously inhibits the secretion of gastric juice. If these two results 
are correct, then the generally accepted assertion of Hueppe, that the 
bacilli find a strong barrier in the acid secretion of the stomach, is 
not only important, but of such a character as to prohibit the use of 
opium. Finally, it has recently been pointed out that the stomach 
actually excretes opium, even when it is given hypodermically, and 
that the opium-nausea can be avoided in the ordinary individual if 
the stomach be washed out as fast as elimination takes place. The 
hypodermic method is therefore little better than the mouth-adminis- 
tration of the drug. Combining all these disadvantages with the fact 
that the majority of observers are doubtful as to its usefulness, we 
ought certainly to resort to opium most cautiously, if at all. 

Camphor, on the other hand, seems to be universally regarded as 
a most useful drug, tending at once to stop diarrhoea and relieve the 
pain and cramps from the beginning to the end of the attack. Whether 
camphor exercises any germicidal effect on the cholera bacillus we do 
not know. Certain it is that volatile oils all possess distinct antisep- 
tic powers. Aside from any such influence, camphor is useful as a 
general systemic stimulant, and has been proved by wide clinical 
observation to have a very extraordinary power in the control of all 
forms of serious diarrhoea, particularly true cholera. The spirit of 
camphor proved most effective in the cholera epidemic of 1866 in 
Bohemia, and the patients themselves stated that they could not 
praise sufficiently the delightful sensation of abdominal warmth and 
stimulating effect of the drug. 

Particularly was this the case where other alcoholic preparations 
had been used, such as "schnapps." Frequently the use of camphor 
so controlled the diarrhoea and stimulated the torpid kidneys that 
anuria was set aside in twenty-four hours. Under these conditions 
camphor wine was found to be very useful, and was made by adding 
75 grains of finely-powdered camphor to a bottle of strong red wine, 
to which was also added gum arabic and alcohol. The camphor was 
first dissolved in the alcohol, and then thoroughly mixed with the 
wine. The dose of this mixture was a teaspoonful, in peppermint 
tea, every hour to a child of six years. For an older child a dessert- 
spoonful, and for an adult a wineglassful. Those who first used this 
mixture were wiser than they thought, for the recent studies of Pick 
have shown that both red and white wine are distinctly inhibitory to 
the growth of the spirillum of cholera, probably because of the tannic 
or other acid which they contain, as well as the alcohol. 



456 DISEASES. 

A remedy, the use of which is based on very rational grounds, is 
salol, and probably the newer drug salophen, which, theoretically, is 
much better than the former, because it is less poisonous. According 
to the interesting studies of Lowenthal, salol seems to be peculiarly 
antagonistic to the bacillus of Koch. This investigator added to a 
50-gramme alkaline solution of pancreatic juice 10 grammes of salol, 
and to this mixture 3 centimetres of a good bouillon culture of the 
bacillus. Examinations in from forty-eight hours to a week showed 
this to be absolutely sterile. It was further proved that the salol was 
inactive until broken up into its component parts — phenol and sali- 
cylic acid. In his experiments on mice Lowenthal found the drug 
protective. Hueppe also asserts that the use of salol prevents the 
development of anuria. This is probably accomplished by its action 
on the bacillus, thereby preventing the diarrhoea and the formation 
of the toxine, both of which influence the blood and kidneys. 

Gonzalez of Salvador, who used salol in the dose of 30 grains at 
the first and 15 grains at the second dose, lost only 3 cases out of 53 
sufferers. 

Nicholson of Patna, India, has also obtained splendid results from 
salol. Given in 15-grain doses every three or four hours for a day 
or two, salol produced a wonderful improvement, and in all his 18 
cases recovery took place, although 11 of them were in a state of col- 
lapse when the salol was first given. Hehir treated 88 cases with 
corrosive sublimate, with a mortality of 44 per cent., and 11 cases 
with salol with no deaths. 

The use of a remedy originally proposed by Dr. R. G. Curtin has 
been proved by recent study to be eminently rational. This remedy 
is sulphuric acid. This drug not only is acid, and so deleterious to 
the bacillus, but, in addition, is astringent, and is probably elimi- 
nated as a sulphate by the lower bowel. As is well known, ordinary 
cholera morbus yields readily to its influence. 

In addition to the treatment already given, which may be used in 
the second as well as in the first stages, we have measures which must 
be resorted to for the relief of the dominant symptoms which mani- 
fest themselves as the disease progresses. 

The symptoms now to be combated are vomiting, excessive purg- 
ing, cramps in the extremities, and, as the result of these, exhaustion, 
collapse, and the advent of the algid stage. By far the best results 
obtained by any one line of therapeutics at this time certainly fol- 
lows the employment of salol and camphor by the mouth, with entero- 
clysis and the use of hot baths ; or, if these are not possible, hypo- 
dermoclysis and the employment of a hot-water bed ; or, finally, hot 
bottles and bricks, for the patient largely dies of cold and of internal 
congestion of thickened blood, the circulation of which the heart and 
vasomotor system are unable to control. Atropine and strychnine 
are very useful, but ether is better than either, given subcutaneously 
or by the mouth, as a diffusible stimulant. 

Very extraordinary results are said by Italian observers to follow 
the rectal injection of a solution of common salt in the proportion of 
1 drachm to the pint (4.0 : 500 cc.) of warm water. In other 



CHOLERA INFANTUM. 457 

instances the use of tannic acid in the strength of from 1 to 8 
drachms to the pint (4.0-32.0 : 500 cc.) of water has proved very 
satisfactory. The amount used at each injection should be about 2 
quarts (2 litres) and the injection made as gently as possible in order 
to urge the fluid high into the bowel. The inflow tube should be a 
soft female catheter, and the overflow tube twice as large as the inflow 
tube. The tubes are to be inserted side by side after thorough oil- 
ing. The injection may be used every two hours and continued till 
the outflow is clear. This is done to wash out poisonous materials 
and to supply liquid to the system. A solution much stronger or 
weaker than that named is dangerous, for similar reasons to those 
given under the head of Dropsy and Saline Purgatives. (See, also, 
Enteroclysis, Part III.) 

Another useful measure is hypodermoclysis, or the passage of a 
solution similar to that just named into the subcutaneous tissues of 
the thigh or belly-wall. (See Hypodermoclysis, Part III.) If done 
slowly these injections are absorbed readily and supply liquid to the 
depleted blood-vessels. 

Very recently Harkin has written in high praise of the so-called 
" vagus treatment " of cholera, and has recorded cases in his own and 
others' practice which reached brilliant cures by the use of a fly- 
blister over the course of the vagus nerve on both sides of the neck, 
just beneath the angle of the lower jaw. The explanation of this 
treatment rests in the belief that cholera is dependent upon some 
impairment of the functions of this nerve in the abdomen. 



CHOLERA INFANTUM. 

Cholera Infantum is a term often applied to all the forms of active 
serous diarrhoea afflicting children in the summer months, whether its 
cause be exposure to high heat, the use of bad food, or both. In 
reality, the term should be applied to that form of serous diarrhoea 
in which heat is the most common cause, and in which symptoms of 
lowered vitality and collapse rapidly come on, with coldness of the 
extremities, pinched face, and wrinkled skin. The treatment by the 
use of drugs is identical in all forms of serous diarrhoea in children 
so far as the purging is concerned, but the removal of the cause 
requires great care in its discovery and skill in its cure. 

In cities, where the heat is often great, the air damp and impure, 
and the food not always fresh, cholera infantum often appears as a 
form of thermic fever or heat-exhaustion, or, in other words, as sun- 
stroke. Often in these cases the temperature in the rectum will be 
found febrile, while that of the axilla is below normal, and, as pyrexia 
does harm to the internal organs, the internal temperature must be 
lowered by cool drinks, by swallowing pieces of ice, and the irri- 
gation of the bowel which will be described in a moment. The diar- 
rhoea in such cases is dependent upon a relaxation of the blood- 
vessel walls in the intestine by reason of the influence of the high 
heat upon the splanchnic nerves, and to irritant matters derived from 



458 DISEASES. 

food resulting from defective secretion of the digestive juices. If the 
thermometer placed high up in the rectum shoAvs a subnormal tem- 
perature, heat-exhaustion is present, not thermic fever, and the treat- 
ment is reversed. Hot drinks are to be used, external heat applied, 
and friction of the limbs resorted to, or the child may be put in 
a hot bath at a temperature of 105° F., its temperature being care- 
fully watched lest it rise suddenly to above the normal. Vomiting 
is nearly always a prominent symptom in cases of cholera infan- 
tum, and if milk is used at all, it is better to use predigested milk in 
teaspoonful doses every fifteen or twenty minutes, although absolute 
avoidance of milk and the use of a feAv drops of beef-juice for twenty- 
four hours is better still. If vomiting is active and collapse is threat- 
ened, good brandy should be used in e;ich teaspoonful of food. And 
the value of atropine as a vasomotor stimulant is not to be forgotten. 
There is another form of cholera infantum which is not due to a 
high atmospheric temperature alone, but more commonly to the inges- 
tion of irritant foods or foods unsuited to a child, obtained by the 
patient surreptitiously or through the ignorance of the parents. If 
there is such a history and some of the masses of undigested food 
have been passed, a purgative dose of castor oil (1 to 2 teaspoonfuls 
[4.0-8.0] to a child of two years), with 20 drops (1.3) of paregoric, 
should be used to sweep out the offending materials and allay irrita- 
tion, and be followed at once by the treatment which will be spoken 
of in a moment. Care, of course, should be taken to maintain the 
bodily heat or lower it if it is above the normal, and a watch must 
be kept upon the pulse and breathing to note any changes requiring 
stimulants. 

Clinically, there is still another class of cases. The physician will 
be called to see a child with the same history of having taken indi- 
gestible food or of there being curds in the stools. Careful examination 
will show that there is much bearing down, or in other cases a simple 
running off of the liquid from the bowel almost Avithout effort. Very 
soon, indeed, the passages become entirely colorless, except for a speck 
or two of green, which shows the presence of the peculiar micro- 
organism Avhich produces this color. The diapers have a peculiar 
mousy odor, and are characteristic ; that is, they seem to be only 
wet and odoriferous, and contain no solid matter. If closely exam- 
ined, they will be seen to be soiled by a small amount of a whitish 
substance, looking like a paste made of Avater and fine chalk. Such 
a passage bodes ill for the child unless treatment is instituted. The 
physician should order, at once, ■£$■ grain (0.003) of podophyllin for a 
child of six months, to be taken in two doses, half an hour apart, in 
20 drops of brandy Avith a little Avater. Two hours after this the dose 
should be repeated, and again in two hours more if necessary. By 
the end of the fourth hour there will be generally seen in the move- 
ments of the boAvels a trace of color, and this will gradually become 
more marked if the case is to have a favorable termination. 

As soon as the movements have changed from the pasty-white 
motions named to those having a bilious color, then, and not till then, 
are astringents to be employed. If they are used before this, the 



CHOLERA INFANTUM. 459 

diarrhoea may become less for a few hours, but the child absorbs 
poisons from its alimentary canal and rapidly goes into collapse. 

The rationale of this treatment rests upon the fact that owing 
to the disease every gland connected with the alimentary canal 
has become inactive through the influence of the micro-organisms. 
It is absolutely necessary to bring about glandular activity, and 
podophyllin, in the experience of the author, is the best remedy for 
this state. During the period that the podophyllin is acting it is 
well to apply a spice plaster to the belly or to immerse the child in 
a hot bath to preserve its bodily temperature. 

In practically every case of cholera infantum it is of the utmost 
importance to stop milk-feeding absolutely for a few days. Nothing 
in the way of food may be given except Valentine's or expressed beef- 
juice, 10 drops (0.65) every two hours with a little cold water until 
all curds and undigested food are removed. 

After these measures have been resorted to, and the chief object — 
namely, a colored stool, not green — obtained, if the diarrhoea con- 
tinues it must be stopped at once to prevent the depletion of the tis- 
sues. The medicinal treatment should consist in the use of a mixture 
such as the following for a child of a year or eighteen months : 

R. — Acid, sulph. aromat gtt. xxx (2.0). 

Tr. opii camphorat fgiij (12.0). 

Elixir, curacose f£ij (8.0). 

Aquee cinnamorai q. s. ad fjiij (96.0). — M. 

S. — Teaspoonful (4.0) in a little water every two hours. 

Or, 

R. — Acid, sulph. aromat gtt, xxx (2.0). 

01. caryophylli ™lviij (0.5). 

Tr. opii camphorat f^j (4.0). 

Spirit, chloroformi gtt. xlviij (3.0). 

Syr. zingiberis q. s. ad f^iij (96.0). — M. 

S. — Teaspoonful (4.0) every two hours. 

If preferred, the tincture of kino or compound tincture of catechu 
may be substituted for the oil of cloves or the spirit of chloroform, 
or, again, the fluid extract of hsematoxylon may be taken in the place 
of either of these. 

Where the vomiting is very severe and incessant, the purging pro- 
fuse, but free from undigested curds, a rectal injection of starch- water, 
2 ounces (64.0), containing 10 drops (0.65) of laudanum, is to be em- 
ployed, and at the same time | of a grain (0.01) of gray powder 
(hydrargyrum cum creta) given every hour if the podophyllin is not 
well retained. The gray powder may in turn be substituted by ^ 
of a grain (0.005) doses of calomel. Very minute doses of arsenic 
given by means of the following solution are often of service in check- 
ing the vomiting and purging, and should be resorted to if necessary : 

R. — Liq. potassii arsenitis gtt. j vel ij (0.1). 

Aqute cinnamomi f^j (32.0). — M. 

S. — Teaspoonful (4.0) every fifteen minutes until four teaspoonfuls (16.0) are taken. 

In some cases the remedies named above only stop the diarrhoea for 
the time being, and it returns as soon as they are withdrawn. In such a 
case the following is of value to restore the lost tone of the parts involved: 



460 DISEASES. 

R. — Resinse podophylli ........ gr. £ (0.03). 

Liq. potass, arsenit gtt. iij vel vj (0.18). 

Liquor calcis fgiij (96.0).— M. 

S. — Teaspoonful (4.0) every five hours. Shake well before using. 

Or a powder may be used : 

B . — Resinae podophylli gr. \ (0.016). 

Pulv. ipecac gr. j (0.06). 

Sacchar. lact gr. xx (1.3). — M. 

Ft. in chart. No. x. 

S. — One powder every five hours. 

A very important, never-to be-forgotten measure in cholera infan- 
tum is the use of counter-irritation over the belly by means of a mus- 
tard plaster (1 part mustard flour to 4 of wheat flour) or by a spice 
plaster. The plaster should be renewed as often as it cools, and kept 
on continuously if the skin will stand it. 

A remedial measure carried out with great success in cities in the 
treatment of cholera infantum is the use of irrigation of the bowels, 
or rather washing out of the colon. This is accomplished by the use 
of the solution named in the articles on Cholera and Enteroclysis. 
The inflow tube should be of soft rubber, like a female catheter. The 
outflow tube should be larger, in order to carry off flakes of food or 
mucus. They may be inserted side by side after being oiled. The 
pressure used should be by a fountain-syringe raised not more than 
three feet above the buttocks, and the outflow should be clear and 
unobstructed. The irrigation may be resorted to every hour or two 
and continued until clear fluid flows away. The solution should, of 
course, not be too cold or too hot — say 100° F. 

CHOLERA MORBUS. 

This acute, painful, rapidly-exhausting disease arises from expo- 
sure to cold, the ingestion of poisonous or irritating foods, exposure 
to excessive heat, or a number of similar causes. 

In reality, it may be regarded in one instance as a gastroenter- 
itis, and in another as an acute serous diarrhoea associated with much 
pain of a griping, rending character. Nothing compares to counter- 
irritation for the purpose of affording relief. A large mustard or 
capsicum draft should be placed over the abdomen and allowed to 
remain as long as it can be borne. If the patient knows that he has 
taken irritant foods, castor oil with 15 to 20 drops (1.0-1.3) of laud- 
anum added to it, to prevent griping, should be employed to sweep 
out the offending masses before any other remedies are used, and be 
followed by an antidiarrhcea mixture, such as here follows : 

R.— Acid, sulph. aroraat f^ij vel f£iv (8.0-16.0). 

Extract. ha?matoxylon fluid. . . . £ij (8.0). 

Spt. chloroformi * fjss (16.0). 

Syr. zingiberis q. s. ad f^iij (96.0). — M. 

S. — Teaspoonful (4.0) every two hours. 

If the pain is very severe, the patient should be given morphine (gr. \) 
and atropine (gr. T ^) hypodermically. (See article on Diarrhoea and 
Cholera Asiatica.) 



CHOREA. 461 

CHLOROSIS. 

(See Anemia.) 

CHOREA. 

St. Vitus's Dance is a nervous affection, generally occurring in 
children, yielding to treatment quite readily in some cases, and in 
others remaining persistently severe, and even becoming worse, under 
the physician's care. 

The disease is always to be treated by the removal of all sources 
of reflex irritation, such as worms, a long prepuce if it is irritated by 
retained urine or smegma, or other trouble of this character, and in 
the avoidance of punishment or severe rebuke on the part of the 
attendants. Except in that form of the disease closely associated 
with or dependent upon rheumatism, the profession universally em- 
ploy arsenic in one of its forms as a specific remedy. Generally 
Fowler's solution is used, and, unless the parents are intelligent 
enough to drop medicine carefully from a bottle or dropper, the phy- 
sician should order a three-ounce mixture (96.0) with 48 drops (3.1) 
of Fowler's solution, so that each teaspoonful will contain 2 drops of 
the drug. Very frequently, to be effective, arsenic must be used in 
ascending closes, increased one drop (0.05) a day, and in consequence 
the dilution just spoken of has to be avoided and the importance of 
care in measurement urged upon the patient's relatives. 

Whenever arsenic is used the physician should instruct the attend- 
ants to stop administering the drug if any puffiness under the eyes is 
seen in the morning on arising from bed, or if any pain in the bowels 
ensues, as these symptoms show that the full medicinal action of the 
drug is being felt. 

When arsenic fails, cimicifuga in the dose of 20 to 30 drops (1.3- 
2.0) of a fresh fluid extract to a child of ten years may be used as the 
next best remedy. 

Where the disease is associated with rheumatism, near or remote, 
the salicylates or iodides may be of value, and should be thoroughly 
tried. 

In some cases of chorea the muscular jerkings are so severe that 
sleep is impossible, and the patient has to be held in bed and the bed- 
covers tied down. These cases will often obtain a quiet night by the 
use of the hot pack at bed-time. (See Heat.) The child should be 
placed in a blanket previously dipped in water as hot as can be borne 
by the patient and thoroughly wrapped up in another (dry) blanket to 
retain the heat, and then be allowed to sweat. Care must be taken 
that a heat-stroke does not result, and, if sweating does not come on 
and oppression ensues, the blanket must be removed. The sheets 
should be ironed to have them warmed for the patient when he is 
returned to bed, and it is often better to let him sleep between dry 
blankets. The efficacy of this treatment is largely increased by the 
use of a dose of bromide of sodium or potassium and a little chloral, 
as follows : 



462 DISEASES. 

R.— Chloralis zij (8.0). 

Sodii bromid ^ss (16.0). 

Aquse dest q. s. ad f |iij (96.0).— M. 

S. — A teaspoonful (4.0) in water every five hours for three doses. 

The nitrate and oxide of silver have been largely used in chorea, 
but are not reliable remedies in this disease. The dose of the first 
should be J to ^ grain (0.008-0.010), and of the second i to J grain 
(0.01-0.016) in pill form. 

Acting on the belief that chorea is due to failure of the inhibitory 
centres, Wood has employed quinine as a stimulant of these inhibitory 
centres, with success in some cases. Full doses should be given, 5 to 
10 grains (0.3-0.65) three times a day. 

CHOROIDITIS. 

Choroiditis, or inflammation of the choroid, is revealed only by 
ophthalmoscopic examination, and may consist merely of increased 
vascularity, of cloudiness due to serous effusion, or of yellowish-white 
patches surrounded by masses of dark pigment, indicating an atrophy 
of the choroid as well as the retina. Numerous groups and clinical 
varieties of choroiditis are described by systematic writers, but it is 
not easy in each instance to determine the cause, which may be local 
in the eye or comprise a constitutional origin, such as syphilis, scrof- 
ula, or gout. In the early or hypergemic stages bleeding from the 
temple is advisable, and later mercury, especially in the form of the 
bichloride, or iodide of potassium, may be given. The constitutional 
state which is present will indicate the suitable general medication. 
All use of the eyes should be forbidden. 

COLIC (HEPATIC). 

This exceedingly painful condition, due to the passage of a gall- 
stone through the bile-duct, is always associated with faintness, 
nausea, and great agony. 

The object of the physician must be to relieve this pain, not only 
by the use of anodynes, but also by aiding in the escape of the stone 
into the bowel. To relieve the pain a hypodermic injection of mor- 
phine J to J grain (0.015-0.03), accompanied by -fa grain (0.001) of 
atropine, is indicated. The morphine not only decreases the pain, 
but allays spasm, and the atropine relaxes the spasm of the muscular 
coats of the ducts and allows the stone to pass through the relaxed 
passage-way. Hot applications, such as turpentine stupes, may be 
used over the liver, but relaxation is not to be obtained by the use of 
nauseating emetics, as the retching or vomiting may rupture the dis- 
tended gall-bladder. Severe rubbing should not be used for the same 
reason. 

Very recently the use of olive or cotton-seed oil has been largely 
resorted to in this affection, and, while we are not sure of the means by 
which it acts, the studies of Rosenberg and others point to the chang- 
ing of the oil into glycerin and fatty acids, the first of which liquefies 
and increases the flow of bile. Often the large dose of oil causes 



CONJUNCTIVITIS. 463 

nausea, and this by producing general relaxation may aid in the escape 
of the stone. The oil is used during the attack of pain, and must be 
swallowed in the dose of half a pint at least ; smaller quantities do 
not suffice. Its action may be aided and its retention in the stomach 
promoted by the addition of a drachm of ether to each dose. 

Shortly after the oil is swallowed sudden relief often occurs, due 
to the escape of the stone into the bowel. The stools should then be 
carefully watched for gall-stones, but care should be taken that the 
lumps of soap which are passed, made from the oil by the alkaline 
juices in the intestines, are not mistaken for true biliary calculi. If 
the pain does not yield to morphine, chloroform or ether may be 
inhaled for the relaxation of the spasm and the relief of pain. 

The treatment of the state predisposing to the formation of hepatic 
calculi consists largely in the use of a moderate, regular diet, devoid 
of much fats, wines, or beers, and in the following of an out-door life. 
It is also claimed that the continuous use of phosphate of sodium or 
Carlsbad salts prevents the formation of hepatic calculi, and that chlo- 
roform spirit has the same power. 

CONJUNCTIVITIS. 

Simple Conjunctivitis, sometimes called catarrhal, acute, or muco- 
purulent ophthalmia, is characterized by congestion of the conjunctiva, 
loss of transparency of the palpebral portion, and some dread of light, 
with a discharge sufficient only to glue the lids in the morning or free 
and muco-purulent. In the milder stages the use of a boric-acid lotion 
(10 grains to the ounce [0.65 : 32.0]) is suitable, and the lids should 
be frequently washed with neutral soap and water ; if there be much 
muco-purulent discharge, the lid should be everted and an application 
made of a solution of nitrate of silver (frcm 2 to 5 grains to the ounce 
[0.1-0.35 : 32.0]). If the discharge becomes great, bichloride of 
mercury, 1 : 10,000, may be employed with advantage, and the 
nitrate-of-silver solution increased to 10 grains to the ounce (0.65 : 
32.0), the excess being neutralized with a solution of salt or washed 
away with tepid water. Much inflammatory reaction in this disease 
may be alleviated by cold compresses. These are rendered more 
efficacious if dipped in equal parts of water and the extract of ham- 
amelis. Patients suffering from catarrhal conjunctivitis should be 
protected from tobacco-smoke, bright light, dust, or any mechanical 
irritant. Atropine usually is unnecessary unless a corneal ulcer com- 
plicates the affection. The patient may wear smoked glasses, but 
under no circumstances must the eyes be bandaged or have poultices 
applied to them. Domestic medication of this sort may change a 
simple ophthalmia into a serious and purulent inflammation. Topical 
medications other than those mentioned are biborate of sodium (gr. 
iv-viij to the ounce), alum (4 to 8 grains to the ounce [0.3-0.5 : 
32.0]), sulphate of zinc (1 to 2 grains to the ounce [0.05-0.1 : 32.0]), 
which may be suitably combined with boric acid, creolin, 1 per cent, 
solution, peroxide of hydrogen, and pyoktanin, 1 : 1000 ; the latter 
remedy, however, has not justified the claims which have been made 



464 DISEASES. 

for it. During the subsidence of the inflammation, and if it shows 
any tendency to become chronic, the application of an alum crystal 
or a solution of tannin and glycerin (10 grains to the ounce [0.65 : 
32.0]) is suitable. It should be remembered that muco-purulent oph- 
thalmia may become epidemic in crowded institutions, and great care 
should be taken to isolate cases. One soiled towel may be the source 
of infection to a great number of children. Constitutional treatment 
ordinarily is not required, but proper hygiene, fresh air, good food, 
the intelligent use of laxatives, tonic doses of quinine, and whatever 
treatment is indicated by any associated condition, are useful. The 
associated conditions most commonly are nasal catarrh, bronchitis, a 
general cold, eczema of the face, and the exanthemata. 

Burns of the Conjunctiva. — Immediately after the accident all 
foreign particles should be removed or neutralized with a weak acid 
or alkaline solution if a liquid caustic or acid solution has entered 
the eye ; then a few drops of cod-liver oil may be instilled and atro- 
pine employed (suitably incorporated with liquid vaseline) to prevent 
iritis. The chief danger lies in the formation of severe corneal 
inflammation and symblepharon ; the latter may sometimes be pre- 
vented by daily breaking up the granulation-tissue or by the insertion 
of a piece of gold-beater's skin between the inner surface of the lids 
and the eyeball. The associated conjunctivitis and keratitis require 
treatment differing in no way from that described in the idiopathic 
forms of these affections. 

Purulent Conjunctivitis, which is commonly seen in the adult in 
the form of gonorrhoeal ophthalmia and in the infant as ophthalmia 
neonatorum, is produced in both varieties by the introduction into the 
eye of a specific virus from either the urethra or the vagina. The 
chief danger of the disorder is destruction of the vitality of the 
cornea and loss of sight. The most important indication is to pre- 
vent this danger by reducing the amount of swelling of the lids and 
conjunctiva and the profuse discharge, which are the characteristics 
of the disease. These indications are met best in the following man- 
ner : Hourly cleansing of the eyes with an antiseptic solution, pref- 
erably bichloride of mercury (1 : 8000) or a saturated solution of 
boric acid. During the acute inflammatory stage, and before the 
discharge is profuse, astringents and cauterants must not be applied. 
When this stage has arrived and the conjunctiva is profusely covered 
with discharge, the lids should be carefully everted once a day, wiped 
clean of every particle of pus,, and carefully touched with a solution 
of nitrate of silver (10 to 20 grains to the ounce [0.65 : 32.0]), and 
the excess neutralized with a few drops of a solution of common 
table salt. In the early stages iced compresses wrung out of car- 
bolized water and frequently changed will help to reduce the reaction, 
or these compresses may be made by placing squares of lint upon a 
block of ice and thus securing intense cold. If the vitality of the 
cornea is threatened, it is advisable, in many instances, to substitute 
for the cold applications hot compresses of a temperature of 110° F. 
These may be applied for from ten to twenty minutes every two or 
four hours, according to the exigencies of the case. The appearance 



CONJUNCTIVITIS. 465 

of ulceration in the cornea calls for the use of atropine or eserine. 
Atropine was formerly employed almost exclusively ; in recent times 
great success has followed the adoption of eserine. This is especially 
applicable if the ulceration should form in the periphery of the 
cornea. In adults high reaction and violent inflammation may be 
alleviated by the use of leeches to the temple. Bleeding of any sort 
is not applicable to newborn infants. Other applications which have 
met with favor at the hands of various surgeons are solutions of sul- 
phocarbolic acid, sulphate of alum, sulphate of zinc, nitrate of silver, 
creolin (1 per cent.), and iodoform ointment. Both blue and yellow 
pyoktanin have been recommended, but do not yield satisfactory 
results. Peroxide of hydrogen is a good cleansing agent, but heal- 
ing does not progress as favorably under its influence as with bichlor- 
ide of mercury and nitrate of silver. Solutions of permanganate 
of potassium and aqua chlorini have many advocates. Mules has 
recommended a treatment with alcohol and corrosive sublimate. The 
preventive method of treating ophthalmia neonatorum that has 
obtained the happiest results is that instituted by Crede' — namely, 
the dropping of a 2 per cent, solution of nitrate of silver into the 
eyes of the newborn infant. If one eye alone is attacked in gonor- 
rhoea! ophthalmia, the other should be protected by covering it with 
Buller's shield, which consists of a watch-glass fixed in a square of 
plaster, which is carefully applied so that the crystal comes directly 
in front of the eye, and the plaster covers the surrounding area. 

Chronic Conjunctivitis may result from an antecedent acute inflam- 
mation of the conjunctiva or exist as an idiopathic affection, especially 
in elderly people, in whom it sometimes becomes a troublesome symp- 
tom, especially if complicating cataract. The characteristic lesions are 
roughness of the papillae of the conjunctiva, swelling of the caruncle, 
and soreness of the angles of the eyelids. There are no granulations, 
although the disease is sometimes inaccurately spoken of as granular 
lids. A soothing wash is indicated (10 grains of boric acid to the 
ounce [0.65 : 32.0] of water), to which may be added 2 grains (0.1) of 
cocaine, provided the cornea is not ulcerated, and for which a similar 
boric-acid lotion with 4 grains (0.3) of salt to the ounce (32.0) may be 
substituted. A very suitable local application is lapis divinus (sul- 
phate of copper 1 part, alum 1 part, nitrate of potassium 1 part, 
fused together, and camphor equal to one-fiftieth of the whole 
added. The mass is run into sticks, and the application made to the 
everted lips, or 1 grain (0.05) of the same preparation to the ounce 
(32.0) of water may be dropped into the eye). Other useful applica- 
tions are tannin and glycerin (10 grains to the ounce [0.65 : 32.0]), 
yellow-oxide of mercury salve, and alum crystal. If refractive error 
exist, this should be corrected. It is to be remembered that chronic 
conjunctivitis distinctly contraindicates any operative interference in 
the eye, as, for instance, cataract extraction. 

Lachrymal Conjunctivitis is a name given to a chronic form of 
inflammation of the conjunctiva, associated with obstruction in the 
lachrymal duct, and characterized by a tear-soaked appearance of the 
eye, small pustules at the roots of the lashes, and a gummy discharge 

30 



466 DISEASES. 

along the palpebral margin. This can be cured only by relief of the 
stricture of the nasal duct which causes it, but may be alleviated with 
the same remedies recommended in the treatment of chronic conjunc- 
tivitis. Good results are reported from the use of pyoktanin. 

Follicular Conjunctivitis — a disease sometimes mistaken for granular 
lids, but having a distinct clinical difference, inasmuch as the swollen 
follicles are absorbed without the production of cicatricial changes in 
the conjunctiva — requires for its local treatment weak astringents and 
antiseptic lotions, and the application to the swollen follicles of an 
ointment of sulphate of copper (gr. J to the drachm [0.025 : 4.0]), 
dusting in calomel either alone or with equal parts of subnitrate of 
bismuth, or iodoform or aristol used in the same way. If the disease 
is stubborn, the swollen follicles should be crushed with forceps. 

This disease, or one analogous to it, is sometimes produced by the 
prolonged instillation of atropine, and less frequently by eserine and 
cocaine. If this is its cause, the drug must be suspended and the 
surface painted with an alum crystal. 

Granular Conjunctivitis. — This disease may be divided into acute 
and chronic granulations. In the former astringents and caustics are 
inadvisable, the eyes requiring weak antiseptic solutions like boric 
acid or salicylic acid and the instillation of atropine. Leeches to the 
temple will aid in reducing the inflammatory reaction. In the chronic 
disease the object of treatment is to bring about absorption of the 
granulations which are its characteristic lesion, not by an application 
so caustic as to destroy the mucous membrane around them, but of 
sufficient vigor to produce healthy reaction. The following applica- 
tions comprise those which have been employed with the greatest 
success: 10-grain (0.65) solution of nitrate of silver if there is dis- 
charge, applied once a day with neutralization of the excess ; sulphate 
of copper in the form of a crystal, carefully applied to the everted 
lids and the retrotarsal folds ; pure carbolic acid, applied with a 
camel's-hair pencil and the excess washed away with water ; glycerole 
of tannin (tannic acid grs. 30 [2.0], glycerin 1 oz. [32.0]), best applied 
with a cotton applicator ; boroglyceride from 20 to 50 per cent., accord- 
ing to the vigor of the granulations. Strong solutions of corrosive 
sublimate are employed in the following manner: Solutions of the 
strength of 1 : 300 or 1 : 500 are painted on the everted lids every 
second day, the pain of the application being alleviated by the pre- 
vious instillation of cocaine, while three times daily the eyes are 
irrigated thoroughly with a solution of the mercury salt, 1 : 7000. 
Among the many other applications which may be used in this disease 
the following may be mentioned : liquor potassa, beta-naphthol, iodo- 
form or aristol in powder or salve, an ointment of the yellow oxide 
of mercury, calomel, and hydrastin. The surgical means which are 
employed to destroy the granulations are scarification of the con- 
junctiva, an inadvisable method; excision of the granulations, use- 
ful if these exist in isolated groups ; crushing the granulations with 
specially devised forceps, a method often followed by satisfactory 
results ; scarification, followed by a vigorous brushing of the affected 
tissue with a brush containing short bristles, previously dipped in a 



CONJUNCTIVITIS. 467 

strong (1 : 500) solution of corrosive sublimate (Grattage) ; and 
excision of the fornix conjunctiva. In long-standing cases asso- 
ciated with inveterate pannus De Wecker has proposed the use of an 
infusion of jequirity (3 per cent.). This produces an intense mem- 
branous conjunctivitis, which must be treated by iced compresses or 
similar measures to reduce its reaction, but when it has subsided the 
pannus is often relieved. This method has not been employed in 
recent times to the extent that it w T as practised when first introduced. 

Diphtheritic Conjunctivitis is rare in this country, but on the con- 
tinent of Europe occasionally occurs as an epidemic. It may appear 
alone or in association with diphtheria of the throat and nose. The 
initial subjective symptoms are those of purulent ophthalmia; the 
characteristic objective symptoms, a board-like infiltration of the lids 
with a deposit of gray membrane upon the palpebral conjunctiva. 
More than in any other eye disease destructive inflammation of the 
cornea is threatened. In the early stages the eye should be fre- 
quently cleansed with boric-acid or bichloride-of-mercury solutions, 
and atropine instilled, while hot compresses help to maintain the 
nutrition of the cornea more perfectly than the cold compresses which 
were formerly recommended for antiphlogistic purposes. Tweedie 
has highly recommended a solution of quinine (3 grains to the ounce 
[0.25 : 32.0]); Burgomaster, insufflation of flowers of sulphur ; while 
in France the local application of lemon-juice or citric-acid ointment 
has been endorsed ; Galezowski uses oil of cade (1 : 10). In the 
early stages all caustics are contraindicated ; after absorption of the 
membrane and re-establishment of the, discharge the cautious use of 
nitrate of silver in the manner described under Purulent Ophthalmia 
may be employed. The constitutional measures for diphtheria are 
necessary. 

Chemosis of the Conjunctiva, in which this membrane is infiltrated 
with serum, is usually a symptom of other ocular disorders, and sub- 
sides with the general treatment directed to their relief. Good results 
may follow nicking the swollen tissue with a pair of scissors, the 
application of a warm, moist compress, and the use of astringents, 
especially alum. 

Hemorrhage beneath the Conjunctiva (subconjunctival ecchymosis) 
may follow an injury, occur during a paroxysm of whooping cough, 
and occasionally, in elderly people, may appear spontaneously. No 
treatment materially hastens the absorption of the blood, unless it be 
massage of the globe through the closed lid; any associated conjunc- 
tival irritation may call for a boric-acid and cocaine wash. 

Xerosis of the Conjunctiva, depending upon a cicatricial metamor- 
phosis and the absence of normal moisture, is seen after long-standing 
inflammations (granular lids, diphtheria, pemphigus), and is incur- 
able. The affection may be relieved by the local use of glycerin, 
almond oil, emulsion of cod-liver oil, or the use of weak alkaline 
solutions. Transplantation of the rabbit's conjunctiva has been 
tried without success. 



468 DISEASES. 

CONSTIPATION. 

This troublesome state depends on a number of causes, the most 
common of which is the following of a sedentary life totally devoid 
of the exercise intended to keep the intestinal and hepatic secretions 
in an active state. Another frequent cause is simple laziness, which 
causes the patient to resist the call of the bowel for evacuation until 
this part of the body becomes indolent and atonic, while modesty 
often causes constipation in females, because a woman prefers to suf- 
fer rather than go to a closet which may be somewhat publicly sit- 
uated. In other instances constipation seems to be hereditary, and 
to depend upon deficient nerve-supply or muscular weakness and lack 
of secretion in the lower bowel, or upon hepatic torpor. 

Whatever the causes are, they should be sought for, and, if pos- 
sible, removed, the physician not being content to order purgatives, 
Avhich, while they may give temporary relief, soon lose their power. 

Further than this, it must be remembered that hygienic measures 
always take first place in the method of treatment, and, if possible, 
drugs should occupy a very secondary role. Particular attention 
should be paid to diet, and the physiology of peristalsis must be well 
borne in mind. 

It has been proved by a large number of studies, both in the nor- 
mal intestine and by the use of purgatives, that peristalsis is almost 
entirely a reflex action depending for its existence upon the integrity 
of the nervous plexuses in the intestinal walls — namely, those of 
Auerbach and Meissner — the first of which are situated between the 
longitudinal and circular muscular fibres which they supply, the latter 
existing in the submucosa and supplying the walls of the villi, the 
glands of Lieberkiihn, and the small arteries and venules. 

It has also been found that the vagus nerve, when stimulated 
reflexly or directly, increases peristalsis, and that moderate stimula- 
tion of the splanchnic nerves decreases it. 1 It at once becomes evi- 
dent that any decrease in the normal activity of these nerves and 
nerve-centres must speedily result in constipation, and the costive 
condition consequent upon hepatic torpor is due to the fact that the 
intestinal walls do not receive the proper stimulation from the bile to 
set in motion a reflex peristaltic wave the result of which will be 
evacuation. This fact rests upon the results of direct experiments, 
which prove the bile to be primarily an intestinal stimulant, antisep- 
tic, and promoter of secretion. 

Other series of experiments have shown that the circulation of the 
blood through the intestines greatly influences peristalsis, and disor- 
ders in the blood-supply readily bring on intestinal disorder. 

The deductions to be drawn from these facts are many. In the 
first place, it is evident that the maintenance of an active, normal 
circulation of blood in the abdomen and a free pouring out of bile 
from the liver and gall-bladder are necessary to a healthy peristalsis; 

1 Some persons believe that Meissner's plexus receives impulses from the walls of 
the intestine and transmits them to the motor plexus of Auerbach, which then sets in 
motion peristalsis. 



CONSTIPATION. 469 

and we find that, aside from drugs, we have a number of remedial 
measures which are to be resorted to according to the means of the 
patient. By far the best of these is horseback exercise for at least 
an hour a day or every other day, which by the motion actively stirs 
up and excites the abdominal viscera as no other measure can do. If 
for any reason horseback exercise is impossible, then abdominal mas- 
sage, carried out by a capable "rubber," is to be tried, the hands fol- 
lowing more particularly the course of the ascending, transverse, and 
descending colon, the kneading movements being also applied to the 
hypochondriac regions. If neither of these measures can be used, 
then the patient must resort to those gymnastic movements which 
involve the abdominal muscles, either by the use of dumb-bells or 
pulleys, such as are sold under the name of "home gymnasiums," or 
by bending the body forward, backward, and laterally, with the fists 
pressed into the hypogastrium. 

At the same time that these measures are directed the diet of the 
patient must be so regulated that the food shall contain a large amount 
of residue — that is, after digestion enough of the husk of the grain or 
enough vegetable fibre must be left free in the intestines to form a 
stimulus to the intestinal wall as it slips over the mucous membrane. 
If a meat diet is largely used, so little residue is left after digestion 
that constipation ensues, but if vegetables are largely eaten the reverse 
is the case. No better evidence of this can be adduced than the hard, 
clay-like passages of the dog and the soft passages of the cow. Very 
often a plateful of cracked wheat (wheaten grits) eaten at breakfast 
each morning, or the use of bran bread, will relieve a chronic tendency 
to constipation. In these cases milk as a prominent article of diet is 
to be avoided above all things, since it is almost entirely assimilated 
and leaves no residue, though it supplants other foods. Green or 
eanned corn is of great service. Fruits do good in constipation in 
one of two Avays — they either contain residual materials or sufficient 
vegetable acid salts to be laxative. Figs, by reason of their many 
small seeds, which scrape the mucous membrane during peristalsis, 
are particularly valuable, and apples, prunes, dates, and tamarinds 
are all useful. It must be remembered that strawberries, raspberries, 
and blackberries are generally constipating rather than purgative. 
In regard to drink, nothing is so good as a glass of cold water taken 
on arising in the morning or just before breakfast, or, if the cold 
cannot be borne, then a glass of as hot water as can be swallowed 
with comfort may be substituted. Coffee is constipating to most per- 
sons, largely because of its empyreumatic oil, and tea has the same 
tendency because of its tannic acid. Brandy, as every one knows, 
is distinctly constipating, and whiskey possesses so little power to the 
contrary as to be devoid of influence in either direction. Beers differ 
in their properties, some of them increasing and some of them decreas- 
ing intestinal activity. 

The patient suffering from constipation should go to stool regularly 
after breakfast every day even if the attempt is abortive, and so train 
the bowel to having a movement at this time. 

The use of drugs for the relief of constipation is capable of division 



470 DISEASES. 

into two parts : first, the employment of remedies to unload the bowel, 
which has become filled ; second, the use of drugs which will so influ- 
ence the intestines as to cause evacuation and produce normal activity, 
or, in other words, drugs which will cure the tendency instead of 
giving temporary relief. Of the first class we find the various pur- 
gative salts, jalap, colocynth, senna, mercury, castor oil, and rhu- 
barb;, of the second class, aloes, cascara sagrada, manna, tamarinds, 
rhamnus frangula (buckthorn), phosphate of sodium, and small doses 
of podophyllin. The physician should bear in mind that defecation 
is a normal physiological act which must be continued all through 
life, and it is almost as foolish to stimulate the bowel continuously to 
peristalsis as to perpetually employ heart stimulants or respiratory 
excitants. 

Although they are habitually employed by many persons in daily 
doses, the purgative salts are exceedingly harmful in such instances, 
rapidly losing their power and decreasing the patient's strength by 
the abstraction of liquids and salts from the blood. They often pro- 
duce anaemia when constantly used. These salines are to be employed 
simply to unload the bowel when an excess of fecal matter has accu- 
mulated or when irritant materials are to be swept out of the aliment- 
ary canal. In some cases of pelvic congestion associated with con- 
stipation magnesium sulphate may be given by enema in the propor- 
tion of 2 ounces (64.0) of the salt, 1 ounce (32.0) of glycerin, and 4 
ounces (128.0) of water. In some rare instances, where great pleth- 
ora exists, a course of Hunyadi water, Friedrichshall or Carlsbad 
waters is of service, but these instances are rare indeed in America. 
Jalap, colocynth, and senna are not to be used constantly, as they 
are too active and the reaction from their effects causes constipation. 
Rhubarb is commonly used, but is of its class peculiarly unfitted to 
its task. Although it purges, it is distinctly astringent, and is there- 
fore more constipating in the end than if no drug had been used. 

Mercury is exceedingly harmful if used continuously as a purge, 
and is the cause of much ill-health, of bad teeth, and of digestive 
troubles. Castor oil is notorious for its tendency to cause ultimate 
constipation. 

Of the curative class of laxatives none compare to cascara sagrada, 
particularly in the form of the non-bitter fluid extract or cascara cor- 
dial. Originally, this drug as prepared was very bitter, but it is now 
made almost tasteless by certain manufacturers. This is the only 
drug which alone moves the bowels and at the same time tends to 
make future passages more easy and regular ; the dose is 10 to 20 
drops (0.65-1.3) of the fluid extract or 1 to 6 drachms (4.0-24.0) of 
the cordial. There is almost no griping produced by it. For the 
regulation of the bowels of young children, particularly if the case 
be somewhat " rickety " in tendency, phosphate of sodium in the dose 
of 5 to 10 grains (0.35-0.65) in milk is the best laxative, and the 
same salt may be used in 30- to 60-grain (2.0-4.0) doses in adults. 
Manna is to be classed as a laxative fruit, but even it sometimes make 
the intestinal torpidity ultimately much worse. The two remaining 
drugs of this class, aloes and podophyllin, should always be used in 



CORNS. 471 

combination with other non-purgative drugs, as is seen in the follow- 
ing formula : 

R. — Aloes socotrin?e gr. xx vel xl (1.3-2.65). 

Extract, rmcis vomicae gr. iv (0.3). 

Extract, physostig gr. iij (0.25). 

Extract, belladonna gr. iv (0.3). — M. 

Ft. in pil. No. xx. 
S. — One pill at night or night and morning. 

Or, 

IJ . — Eesina? podophylli gr. ij vel iv (0.1-0.3). 

Extract, nucis vomicae gr. iv (0.3). 

Extract, physostig gr. iij (0.25). 

Extract, belladonnse gr. iv. (0.3). — M. 

Ft. in pil. No. xx. 
S. — One night and morning. 

The object of using several of these drugs is seen at a glance. 
We have already learned that nearly all purgatives tend to produce 
griping. The mix vomica acts as a bitter tonic and stimulant, and 
prevents subsequent atony of the mucous membrane, as well as increases 
reflex action, and consequently improves peristalsis ; the physostigma 
is a tonic to the unstriped muscular fibre and gives it strength ; the 
belladonna aids peristalsis by depressing the inhibitory fibres of the 
splanchnic nerves, by allaying spasm, and by decreasing griping. In 
using these drugs, aloes and podophyllin, we should remember that 
aloes is sIoav and acts particularly on the lower bowel, and that podo- 
phyllin acts chiefly on the upper bowel and is the slowest purge in 
the list of purges. 

In the flatulence of old persons associated with constipation a little 
asafoetida or capsicum should be added to the pill of aloes just named. 

In some instances constipation arises from reflex irritation or from 
ovarian or bladder trouble or from chronic lead poisoning. This form 
of constipation may resist all purgatives and yield to opium or to 
tobacco, which quiets reflex action. Tobacco depresses the inhibitory 
nerves of the gut, and devotees of the " weed " often use it as a lax- 
ative. 

The employment of enemata as a routine practice is to be discour- 
aged. In cases where it is necessary to use them for temporary relief 
and to get rid of flatulence, a little soap, common salt, or a few drops 
of turpentine may be added to the water. Recently the injection of 
glycerin (1 to 2 ounces [32.0-64.0]) has been largely resorted to, 
either pure or diluted one-half, and this method has been improved 
upon by the use of glycerin suppositories containing many drops of 
the drug. Glycerin acts in these cases as an irritant to the mucous 
membrane, and causes secretion by this means and by its abstraction 
of water from the tissues by reason of its hygroscopic powers. It is 
capable, however, of causing a good deal of rectal irritation in some 
persons. 

CORNS. 

These troublesome formations are best treated by the use of sali- 
cylic acid, the following formula being applied night and morning for 



472 DISEASES. 

several days, after which the part should be well soaked in hot water, 
when the entire corn will readily come away, or in some cases several 
attempts will be necessary : 

R. — Acid, salicylic gr. xxx (2.0). 

Extract, cannab. indicae gr. x (0.65). 

Collodii f 3ss (16.0).— M. 

S. — Apply with a camel s-hair brush. 

The same acid may be used in alcohol, and lactic acid in the same 
proportion is often of service. 

In the so-called "soft corns," with much inflammation, the foot 
should be washed and dried, and a saturated solution of nitrate of 
silver, 60 grains (4.0) to 2 drachms (8.0), applied to the part every 
four or five days. 



CORYZA (ACUTE). 

The treatment of coryza of the acute variety, the form which most 
frequently presents itself to the physician for relief, is followed in 
many instances by such marked amelioration of the symptoms and 
shortening of the attack as to encourage medical interference. It 
must be remembered, however, that the duration of the condition 
before the patient presents himself has much to do with the progno- 
sis, for if the tissues of the nasal chambers have become boggy and 
swollen with exudation recovery must be more prolonged than if rem- 
edies are applied in the early stages of the catarrhal process. The 
treatment locally consists in the following measures for relief: By 
means of a medicine-dropper or an atomizer a few minims of a 4 per 
cent, solution of cocaine are dropped into the nostrils, the patient's 
head being well tipped back. After the peculiar constringing influ- 
ence of the cocaine has shrunken the congested mucous membrane, 
so that the patient can draw air through the nostrils, the nasal cham- 
bers should be washed clean of mucus by means of the following 
lotion in an atomizer : 

R. — Sodii chloridi gr. xv (1.0). 

Acid, boric gr. x (0.65). 

Sndii borat gr. x (0.65). 

Aqua?dest fgiij (96.0).— M. 

The parts being thoroughly cleansed, a fine spray of the following 
should be used as antiseptic, sedative, anaesthetic, and protective : 

R. — Menthol gr. viij (0.5). 

Camphor . gr. v (0.3). 

Albolene f Jj (32.0).— M. 

In this prescription the menthol exerts an anesthetic effect, and pro- 
longs the constriction of the parts produced by the cocaine, so avoid- 
ing the secondary capillary dilatation due to that drug. The camphor 
exercises its well-known soothing influence, and the albolene protects 
the membrane from dust and irritants. If the congestion has a tend- 



CROUP. 473 

ency to return, it is well to use a solution of antipyrine, 2 to 4 grains 
to the ounce (0.1-0.2 : 32.0) of water, as a spray to prolong still 
further the effect of the cocaine. The albolene spray should follow, 
not precede, the antipyrine, as the oil would prevent the antipyrine 
from acting. Under no circumstances should the antipyrine be used 
without the cocaine preceding it, as the pain is too severe. 

The internal treatment consists of a hot foot-bath, with mustard 
in it in the early stages of the disease, and the taking of a hot drink, 
such as lemonade with whiskey in it, on going to bed. Often 20 or 
30 drops (1.3-2.0) of sweet spirit of nitre added to this will increase 
its diaphoretic effect. In other cases, particularly in strong, hearty 
men, 5 to 10 grains (0.3-0.65) of Dover's powder at bed-time will be 
better. This line of treatment is of little value after secretion has 
been fairly established, and in its place supportive measures are indi- 
cated. Small tonic doses of quinine, 2 to 4 grains (0.1-0.2) three 
times daily, sometimes combined w r ith the use of 5 to 10 grains (0.3- 
0.65) of chloride of ammonium, as prescribed in the article on Bron- 
chitis, are useful. Where much headache is present full doses of the 
bromide of potassium or sodium are to be given, and the spray treat- 
ment already named is to be persisted in while the attack lasts. 



CROUP. 

(See Diphtheria.) 

CROUP (SPASMODIC). 

As this is a spasm of the glottis depending for its causation upon 
catarrh of the mucous membrane of the larynx, and as it is due most 
commonly to some reflex irritation, such as dentition, indigestible 
food, or sudden atmospheric changes, the treatment is both prophy- 
lactic and curative. Prophylaxis consists in the avoidance of cold, 
the use of a simple diet, particularly at the evening meal, the render- 
ing of the air of the bedroom moist by means of steam or at least by 
the avoidance of dust-laden, furnace-heated air, and by the removal 
of dental irritation and nasal hypertrophies, which make the child a 
" mouth-breather." Small doses of the bromides, chloral, belladonna, 
or opium may be resorted to at bed-time. A very useful prescription 
for this purpose is that which follows : 

R.— Sodii bromidi £j (4.0). 

Syrupi lactucarii f?ij (64.0).— M. 

S. — Teaspoonful to a dessertspoonful (4.0-8.0) on going to bed, and once or twice dur- 
ing the night if needed. 

When the attack is present a cold cloth should be wrapped about 
the neck and the child placed at once in a hot bath, the air of the 
room being moistened by the steam escaping from a kettle of boiling 
water or by pouring water upon unslaked lime. If the paroxysm is 
very severe, a few whiffs of amyl nitrite may be employed, or anti- 



474 DISEASES. 

monial wine in the dose of 2 drachms (8.0) may be used to cause vom- 
iting. It is also useful to disseminate the fumes of menthol through 
the air of the room by heating some crystals in an iron spoon. If 
the fumes are strong enough to produce a distinct odor, they are 
present in sufficient amount. 

The drugs first named do good by decreasing reflex excitability, 
while the emetics indirectly relax the spasm by the nausea and 
depression which they produce. 



CYSTITIS (ACUTE). 

If, by reason of exposure to cold, injury, the introduction of for- 
eign bodies, such as dirty catheters, or the presence of gonorrhoea or 
other disease due to a septic poison, an acute inflammation of the 
bladder ensues, it is accompanied by a sensation of weight and ves- 
ical fulness, by pain, tenesmus, and inability to retain the urine. 
Sometimes the last-named condition may be reversed and retention 
of the urine be present. 

If the general system responds to the local inflammation, as evi- 
denced by increased arterial excitement and fever, aconite in full 
doses of the tincture should be used, and it should be combined with 
small amounts of sweet spirit of nitre and citrate of potassium, as 
follows : 

R.— Tinct. aconiti tt (4.0). 

Spirit, aether, nitrosi f^j (32.0). 

Liquor potassii citratis q. s. ad f^vj (192.0) — M. 

S. — Dessertspoonful (8.0) every four hours until all fever ceases and the pulse is quiet. 

At the same time a hot compress should be applied over the blad- 
der, but it should not contain turpentine or any irritant substance 
which may be absorbed from the skin and when eliminated by the 
kidneys irritate the bladder-walls. Leeches may be placed upon the 
perineum or cups applied to the region of the sacrum. In some cases 
belladonna may be used with or without aconite in the dose of 5 to 
10 drops (0.65) of the tincture three times a day, and it is worthy of 
note that this drug is particularly serviceable in the cystitis due to 
cold ; 5 drops of liquor potassa every four hours may be substituted 
for the citrate of potassium, or the acetate of potassium may be used. 
If there is much pain and bearing-down, an enema of 30 drops (2.0) 
of laudanum in 2 ounces (64.0) of starch-water may be employed, 
or the opium may be given in suppository. 

Sometimes a belladonna suppository is of more service, and an 
iodoform suppository will often relieve the pain by its local anaes- 
thetic effects. Hot enemata, without any drugs, are often valuable 
as a means of relief, and a hot sitz-bath is very efficacious. Can- 
nabis indica, if an active preparation can be had, is better than opium 
to relieve the pain, since it seems to affect the bladder favorably. 
The other curative measures are hygienic, and consist in the main- 
tenance of the recumbent posture, absolute physical and mental rest, 



CYSTITIS. 475 

the avoidance of all foods which are stimulating, as rare meats and 
highly-seasoned dishes, and abstinence from all varieties of alcoholic 
beverages. 

Should the inflammation be severe enough to become purulent, 
the physician should order salol in the dose of 10 grains (0.65) three 
times a day. This drug, being broken up in the bowel into carbolic 
acid and salicylic acid, is so eliminated and renders the urine anti- 
septic. ' 

Laxatives are to be employed with persistence if the bowels are 
confined, and salines in the early stages are generally better than 
vegetable purges. 

Quinine should not be used against the fever, as it is contraindi- 
cated, owing to its irritant effects upon the bladder. 



CYSTITIS (CHRONIC). 

The treatment of chronic cystitis is entirely different from that of 
the acute form, and consists in the use of remedies which will stim- 
ulate the diseased mucous membrane, cause a normal secretion of 
mucus, and so influence the urine that the mucus already formed will 
be passed out and the fluid rendered alkaline or acid, as may be 
desired. When the secretion of mucus in large amount is persistent, 
the urine should be rendered alkaline by the use of liquor potassa or 
the citrate, acetate, or bicarbonate of potassium. The bitartrate of 
potassium is eliminated as the bitartrate of potassium, and, as it is 
acid, cannot be employed. 

We acidify the urine when it is necessary to dissolve the phos- 
phates and to prevent deposits in the bladder and elsewhere. The 
two best drugs for this purpose are boric acid in the dose of 5 to 
10 grains (0.65) or benzoic acid in the same amount. Both of these 
may be given in pill form, made by adding a little glycerin. The rule 
may be laid down that if the urine is high-colored and is strongly 
acid, alkalies are useful ; whereas if it is light in color, but loaded 
with phosphates, the acids named should be employed. Salol may be 
given to prevent decomposition of the urine. 

One of the best measures for the relief of chronic cystitis is to 
wash out the bladder daily by irrigation with warm water or water 
containing bichloride of mercury in the proportion of 1 : 10,000, as 
this washes away all mucus and uric-acid deposits and prevents irri- 
tation. Solutions of nitrate of silver have been used with great suc- 
cess where the discharge is muco-purulent, and Thompson recommends 
the use of a solution of the strength of 1 grain to 4 ounces (0.05 : 
128.0) of water, gradually increased to 2 grains to the ounce (0.1 : 
(32.0). Others, such as Gardner, Richardson, and Potter, recommend 
the use of stronger solutions, 5 grains to the ounce (0.35 : 32.0) of 
water, claiming that while these amounts may produce serious effects 
in some instances, they are very efficacious in obstinate cases. The 
physician should have at hand a solution of common salt, which he 
should inject into the bladder at once if the action of the silver solu- 



476 DISEASES. 

tion is too painful or seems excessive. This treatment is only suited 
to the most chronic cases. 

The remaining remedies which are employed internally in chronic 
cystitis are those which are directed to the improvement of the mucous 
membrane of the bladder, and consist of buchu in the form of the 
fluid extract in the dose of J to 1 drachm (2.0-4.0), well diluted; 
arbutin or ursin, 3 to 5 grains (0.25-0.35); or the fluid extract of 
uva ursi, dose 30 drops to 1 drachm (2.0-4.0). All of these are better 
fitted for the treatment of subacute than chronic cystitis, as they are 
not sufficiently active for the chronic forms. 

In cystitis of an advanced type, with great vesical atony, strych- 
nine is of service, and drop-doses of tincture of cantharides do great 
good. Turpentine may also be used with advantage in 5- to 20-drop 
(0.3-1.3) doses, as may also the oils of eucalyptus, sandalwood, cubebs, 
and copaiba. 

All these measures are suitable for the treatment of cystitis in the 
male and female, but it is to be noted that injections into the female 
bladder are made much more readily than into that of the male, 
because of the shortness of the female urethra. In either case the 
operation is best performed by attaching a small funnel to a soft- 
rubber catheter and filling the bladder by raising the funnel full of 
water above the patient's belly. Creolin has been highly recom- 
mended by Parvin in the strength of from 1 to 2 per cent, with water. 
The irrigation is to be performed every twenty-four hours. 



DIABETES INSIPIDUS. 

In diabetes insipidus the disorder exists simply as a profuse urinary 
flow dependent upon some disorder of the innervation of the kidney 
or upon atony or relaxation of this organ. This treatment consists 
in the use of astringents and tonics, and in some cases in the employ- 
ment of opium or belladonna, particularly if the over-secretion rests 
upon nervous irritability. Gallic acid may be used in 20-grain (1.3) 
powders three times a day, and the fluid extract or wine of ergot is 
often of service given in the dose of 30 drops to a drachm (2.0-4.0) 
of the former or a wineglassful (32.0) of the latter. As tonics the 
sulphate of iron and strychnine are indicated. 



DIABETES MELLITUS. 

In the treatment of this affection it should be remembered that it 
is the result of disordered function, and is not a disease in itself, but 
a symptom of several disease-processes. For this reason a remedy 
which succeeds in one case may fail in another. 

The treatment of diabetes mellitus is dietetic and medicinal. The 
diet list should consist largely of meat, particularly of meat with 
some fat attached to it, as the fat, to some extent, takes the place of 



DIABETES MELLITUS. 477 

starch in the nutrition of the body. The avoidance of starches of all 
kinds and the use of dry wines or those containing little or no sugar 
are to be insisted upon. Beers and malt liquors must be forbidden. 
According to some authorities, the patient should be placed in bed 
and put on a purely milk diet, generally of skimmed milk, although 
buttermilk is better than any other form, owing to its lactic acid and 
lack of sugar. Koumyss for the same reason is very valuable. The 
chief aim of the patient must be to avoid all substances which can 
be readily converted into sugar by the organism. > 

The following list of foods and drinks may be taken, and the 
second list forbidden i 1 

Meats of all kinds (except liver), eggs, fish, cheese, butter, and 
cream ; oyster-plant, asparagus (?), tomatoes, almonds, pecan nuts, 
butternuts, walnuts, and cocoanuts ; string-beans, beet tops, radishes, 
mushrooms, lettuce and water-cress, cauliflower, spinach, and onions. 
Celery and cucumbers may also be permitted. 

Of the foods and drinks to be avoided, we have all forms of sugar, 
all forms of starch, such as ordinary flour, cornmeal, arrowroot, sago, 
tapioca, oatmeal, barley, carrots, beets, parsnips, pie-plant, peas and 
beans, chestnuts, and most of the fresh fruits, cider, beers, champagne, 
sweet wines, and honey. 

The treatment of diabetes by drugs is varied by the condition of 
the patient, the cause of his disease, and the quantity of sugar in the 
urine. While the drugs most commonly employed are used in many 
instances without any knowledge of how they act, and have each of 
them a set of warm supporters among prominent authorities, much of 
the treatment must depend upon whether or not a rheumatic or gouty 
taint is the cause of the trouble, or whether it is due to high living, 
little exercise, and a plethoric, congested, overloaded system. In the 
first class of cases iodide of potassium and the salicylates will be most 
serviceable ; in the second class, a restricted diet, moderate exercise, 
and purgation to relieve engorgement of the hepatic artery and veins 
may be needed. In the cases of gouty diabetes, where relief does not 
follow the use of the iodides and colchicum, resort must be had to 
arsenic and lithium citrate or carbonate, a combination peculiarly 
adapted to such a condition, according to several authorities. Indeed, 
arsenic is a sheet-anchor with many practitioners in all forms of dia- 
betes, and should be given in fairly large, constantly-repeated doses 
for a long time. A very much larger body of medical men rely on 
opium or one of its alkaloids, such as morphine or codeine. The for- 
mer is used in the dose of J to \ grain (0.015-0.03) three times a 
day; the latter, 1 to 5 grains (0.05-0.3) three times a day, and the 
writer has found them very useful. The morphine is much the most 
powerful for good, and patients who are diabetic must have large 
ascending doses, which they bear very well. The chloride of gold and 
sodium (y 1 -^ grain [0.006]) has been highly recommended by Bar- 
tholow, and ergot by Wood and DaCosta. In cases depending upon 

1 It is worthy of note that certain persons may have a slight glycosuria without 
serious injury, who waste under a limited diet, requiring ordinary fare to support the 
body plus the diabetic drain. 



478 DISEASES. 

rheumatism the use of salicylic acid is often of great value, the dose 
being 10 to 15 grains (0.65-1.0) three times a day. 

In cases of diabetes in which diet will control the disease the best 
clinicians insist that drugs should be avoided, for when opium or any 
of its alkaloids are used it is necessary to give rapidly-increasing 
doses, which finally become enormous, as much as 7 grains (0.6) of 
morphine a day being taken by some persons. Once having begun 
the use of drugs in severe cases, it is very dangerous to stop them, 
for clinical experience has shown that many of these patients waste 
rapidly and generally break down when this is done. In regard to 
the time of day at which to give the morphine or codeine, it is gen- 
erally considered best about one hour after meals. Under the cir- 
cumstances the drugs seem to decrease diuresis more than if the dose 
precedes the meal ; further than this, the stomach is not disordered. 
In some cases results will be obtained from opium when its individual 
alkaloids fail. Careful observation of the patient should be carried 
out to determine the proper beginning and subsequent doses, and if 
at first the opiates fail to give relief, discouragement should not 
be felt. 

Jambul is a remedy which has been widely used by clinicians for 
the relief of diabetes with such varying results that its position in 
therapeutics is uncertain. This is probably because it is effective in 
one form of diabetes and not in another, and we are unable to make 
the clinical distinction. Jambul is used in powder or the powder is 
placed in capsules or pills. The dose is 5 to 30 grains (0.3-2.0) once 
to thrice daily, and gradually increased. As much as an ounce (32.0) 
has been given in twenty-four hours. This medicament is said to be 
advantageously combined with a pure meat diet in diabetic cases. 

The excessive thirst of diabetes can be best allayed by the use 
of acidulated water or alkaline waters containing non-purgative salts. 
It is useless to cut off the water-supply, to the production of great 
suffering, but the patient should use moderation in drinking so far as 
possible. 

The wasting coming on in diabetes is to be treated by careful 
diet, rest, and the supply of all the food which the patient can 
digest. In many instances the amount of aliment ingested is extra- 
ordinarily large, while in others digestion is so impaired that food 
cannot be taken. 

If cachexia comes on, iron, strychnine, bitter tonics, the lacto- 
phosphates of lime and sodium, and astringents are to be used to sup- 
port the circulatory and nervous systems. Tea and coffee and all 
forms of food needing sweetening may be rendered palatable by the 
use of saccharin or of glycerin. The former passes through the body 
unchanged ; the latter increases the glycogen in the liver, but checks 
the formation of sugar (Ransom). 

Unfortunately, we have no positive knowledge as to the minute 
and innermost causes of diabetes, nor the manner in which the glyco- 
suria is brought about, and in consequence cannot explain the manner 
in which opium, codeine, or other drugs produce relief. 

Diabetic coma is a most dangerous complication of this disease, 



DIARRHOEA AND DYSENTERY. 479 

and should be treated as actively as our knowledge of its cause per- 
mits. It is thought by some that the symptoms are entirely depend- 
ent upon the presence in the blood of oxybutyric acid, and that 
hypodermoclysis or intravenous injection of normal saline solution 
(7 : 1000) should be resorted to. Stadelman insists upon the employ- 
ment intravenously of 150 cc. of normal salt solution to which 7.2 
gm. of sodium carbonate and 4.6 gm. of sodium bicarbonate have 
been added. The injection is continued until the urine is alkaline. 
Unfortunately, the statistics of this method of treatment are only a 
little better than nil, as so far the mortality has been 10 out of 11 
cases. Hypodermic injections of ether should be resorted to to sup- 
port the heart. 



DIARRHOEA AND DYSENTERY. 1 

Diarrhoea is a term loosely applied, with perfect correctness, to all 
forms of intestinal disturbance accompanied by the passage of liquid 
stools, and its meaning, "to run through," expresses the state it 
represents. 

The treatment of each form of diarrhoea depends upon its cause, 
and no case can be intelligently treated in which the physician fails 
to recognize this aspect of the case. Diarrhoea is but a symptom, not 
a disease, and must be regarded solely as an evidence of intestinal 
disorder. 

While the same drugs are prescribed in many forms of the trouble, 
we may divide cases of diarrhoea into four classes, as follows : {a) 
Those in which the laxity is due to a catarrh, acute or chronic, of 
the intestinal mucous membranes, causing the passages to contain 
mucus ; (b) those where, owing to disordered innervation, a profuse 
outpouring of liquid takes place from the blood-vessels into the 
intestinal lumen ; (c) those in which, owing to disease, the glands 
fail to prepare juices to digest the food properly ; and, finally (d) those 
cases where ulceration causes irritation and bloody purging. 

The treatment of the catarrhal form first named consists primarily 
in the regulation of the diet, which should be made up chiefly of milk, 
boiled or predigested, or of milk whey, and in the administration of 
castor oil or other mild purge, such as sulphate of magnesium, to 
sweep out fermenting food and mucus. Enough laudanum should 
accompany this oil to prevent griping, and it is well to add bicarbon- 
ate of sodium, grains 20 to 30 (1.3-2.0) to the dose, both to aid the 
action of the oil and to render the bowel alkaline in reaction (normal) 
instead of acid, as caused by the fermentation abnormally present. 
A mustard plaster or other counter-irritant should be applied to the 
abdomen. Often in the milder forms of mucous diarrhoea this is all 
that is needed, but more frequently it must be followed by the use of 
tonics and astringents, such as nitrate of silver and hyoscyamus, in 
the following pill : 

1 The articles on Cholera, Cholera Morbus, and Cholera Infantum should be care- 
fully read in connection with this article. 



480 DISEASES. 

R. — Argenti nitratis gr. ij (0.1). 

Extract, hyoscyami gr. v (0.3). — M. 

Ft. in pil. No. x. 
S. — One three times a day. 

Or, 

R.— Plumbi acetatis gr. ij (0.1). 

Extract, opii gr. ij (0.1).— M. 

Ft. in pil. No. x. 
S. — One three times a day. 

If these stop the diarrhoea, yet there still seems to be a tendency 
for it to return or atony is present, we should use a pill containing 
the extract of chiretta or employ nitromuriatic acid, or, better still, 
nitric acid and cardamoms, because the constant tendency to relapse 
indicates a deficient secretive action on the part of the intestinal 
glands, which these remedies are prone to improve : 

R.— Acid, nitric, dil f3J.(4.0). 

Tr. cardamomi comp f|ij (64.0). 

Tr. gentian, comp 13 ij (64.0).— M. 

S. — Dessertspoonful (8.0) every four hours. 

If the catarrhal state is persistent, no remedy compares to the 
chloride of ammonium, dose 5 grains (0.3) every four hours in liquorice 
and water. Where the catarrhal state is exceedingly chronic and 
obstinate it is well to employ 3- to 5-grain (0.15-0.3) doses of potas- 
sium iodide. 

If the pills already named do not control the diarrhoea, and the 
discharges are so profuse as to weaken the patient very greatly, the 
following prescription may be used to check the movements, but not 
to stop them completely : 

R . — Acid, sulph. aromat f^jss (6.0). 

Spt. chloroformi f.^ij (8.0). 

Tr. opii camphorat fjf ij (64.0). 

Syr. zingiberis q. s. ad f^iv (128.0). — M. 

S. — Dessertspoonful (8.0) every two hours. 

Or, 

R.— Tr. kino f^j (32.0). 

Tr. catechu comp f^j (32.0). 

Misturse cretse f.^iij (96.0). 

Aquae cinnamomi q. s. ad f^vj (192.0). — M. 

S. — Shake well before using. Tablespoonful (16.0) every three hours. 

In many cases where the condition of mucous diarrhoea becomes 
chronic it is necessary to resort to enteroclysis (Part III.) and the 
treatment needed in cases of chronic intestinal catarrh. (See Diar- 
rhoea, Chronic.) 

In the second form of diarrhoea named — that in which serous or 
watery purging is present — the treatment is radically different. In 
these cases the blood-vessels of the gut aro relaxed and leaking, and 
must be contracted and made water-tight. This dilatation may result 
from fear ("nervous diarrhoea"), from exposure to cold, or from 
exhaustion, extreme heat, and irritant food. If from irritant foods, 
they are generally swept out in the first flush of liquid. 



DIARRHCEA AND DYSENTERY. 481 

The measures to be adopted consist in those directed to the con- 
traction of the dilated and relaxed blood-vessels and the restoration 
of the proper nerve-supply to the parts. 

As the splanchnic nerves are the vasomotor nerves of the intestine 
as well as the inhibitory nerves of peristalsis, it is evident that we 
must use drugs which will cause stimulation of these fibres, and the 
chief of these is found to be opium, which diminishes intestinal peri- 
stalsis and secretion by just such an influence. In the same way 
small doses of volatile oils are of service, and camphor and spirit of 
chloroform may be used. As there is relaxation, astringents are indi- 
cated ; and as sulphuric acid is not only astringent, but eliminated 
by the lower bowel, it is peculiarly serviceable. We find, therefore, 
that the following prescription fulfils every indication : 

R. — Acid, sulph. aromat f.^ss (16.0). 

Olei cajnputi gtt. xl (2.65). 

Ext. hfematoxyli fl f^ij (8.0). 

Spt. chloroformi f^j (4.0~). 

Syr. zingiberis q. s. ad f^iij (96.0). — M. 

S. — Teaspoonful (4.0) in water every two or three hours. 

If desired, kino or catechu may be used in lieu of the hoematoxylon, 
or the oil of cloves substituted for that of cajuput. Camphor or pare- 
goric may also supplant these drugs. 

In some instances these attacks appear to depend upon hepatic 
disorder, and the only cure, aside from partial relief, is to be obtained 
by the use of 2 to 6 grains (0.1-0.35) of mercury with chalk (hydrar- 
gyrum cum creta) or calomel, given in ^ to \ grain (0.01-0.03) doses. 
What is said of intestinal disorder from lack of secretion under the head- 
ing of Cholera Infantum applies very forcibly to these cases, and diar- 
rhoea may persist for weeks, or only temporarily be held in check by 
the most powerful drugs, until the physician thoroughly flushes the 
intestine with bile by the use of podophyllin and calomel. 

Wood has highly recommended the use of a bismuth powder con- 
taining a drop or two of carbolic acid. 

The third class of cases seems, in many instances, to lie between 
those just spoken of and those in which the writer has placed them ; 
they occur chiefly in children, and consist in the foetid, " mousy "- 
smelling stools of summer diarrhoea, with green, spinach-like masses 
of semi-digested food or distinct lientery. They may be due to defici- 
ent glandular action in any part of the alimentary canal, and are 
often cured by the use of pepsin and hydrochloric acid to aid the 
gastric processes. In other instances the duodenum is at fault, and 
should be stimulated by small doses of nitromuriatic acid, or by podo- 
phyllin in the dose of -JL- to -^ of a grain (0.001-0.0015), with a little 
milk-sugar, or given in alcoholic solution. Similarly, ipecac in pow- 
dered form may be used in the dose of \ to \ a grain (0.015-0.03) 
three times a day. In the case of children, who are often sufferers 
from rickets, phosphate of sodium, lime salts, and common salt should 
be freely given. 

For the purpose of establishing intestinal antisepsis, carbolic acid 
may be used, and naphthalin, thymol, and other drugs of this class 

31 



482 DISEASES. 

have been employed, particularly salicylic acid. None of them com- 
pare with carbolic acid, however, which should be used in 1-drop 
(0.05) doses on bismuth or in water. When the carbolic acid is given 
to a child, it is best prescribed in such a way that in each teaspoonful 
a half-drop is present. This teaspoonful of liquid should be placed in 
a tablespoonful of water. In other cases sulphocarbolate of zinc in 
the dose of from 1 to 4 grains (0.05-0.2) in powder or capsule is 
beneficial. Salol combined with chalk mixture may also be advan- 
tageously used. (See prescriptions under Salol.) 

Sometimes a good-sized, brisk purgative dose of calomel followed 
by a saline does good in these cases if they are strong enough to 
permit of its use. 

The regulation of the diet, which should consist in sterilized milk 
or koumyss, the former being predigested, is of the greatest import- 
ance. Should the patient be a bottle-fed baby, the proportions of the 
milk, water, and cream placed in the bottle should be varied until a 
mixture is formed which is exactly fitted to the digestion of the case. 

The after-treatment consists in the use of tonics and a carefully 
regulated diet, which should be largely composed of milk and milk 
foods. 

The fourth type, generally known as dysentery, is due in some 
cases to hepatic trouble, in others to the drinking of impure water, 
and in the third place to exposure to heat and bad food. It is in 
most cases a very obstinate form of diarrhoea, requiring much skill 
and patience for its cure. In the chronic forms deep ulcers may 
exist ; even in the milder cases a high inflammation is often present. 

In those cases which are due to exposure to heat and hepatic 
trouble there are two remedies which are far above all others in value 
and should always be resorted to. The first of these is ipecac, the 
second is calomel. 

The ipecac should be used in a special manner to be effective (see 
Ipecac), and the calomel should be used in full purgative amounts, but 
is contraindicated if much weakness is present. 

If the passages are slimy and bloody, -^-q of a grain (0.0003) of 
bichloride of mercury every hour or two is of service, and if much 
blood is present high rectal injections of the distilled extract of hama- 
melis and water half and half are of value. In some forms of dys- 
entery due to acute inflammation large enemata of iced water are of 
the greatest value. The water should be ice-cold, and at least a quart 
injected by hydrostatic pressure. This method can only be used in 
strong persons, and is very useful in that it also aids in reducing any 
fever which may be present. The following mixture may be injected 
into the bowel in place of cold water in feeble cases : 

R.— Sodii boratis . . / 3j (4.0). 

Tinct. benzoin f^j (4.0). 

Spt. camphors? fly (32.0). 

Aquse ferventis ... Oij (1 litre). — M. 

If the ulcers are very old and chronic, nitrate-of-silver injections 
of the strength of 10 to 20 grains (0.65-1.3) to the pint (500 cc.) of 
water may be employed in large bulk, a salt solution being at hand 



DIABRHCEA. 483 

for the destruction of the silver salt if the action which ensues is too 
severe. 

Recently the injection of water or medicaments into the bowel for 
the purpose of influencing the intestinal wall has given way in the 
hands of prominent physicians to irrigation by means of an inlet and 
outlet tube. The inlet tube should be attached to a fountain syringe, 
and the outlet tube be long enough to reach to a vessel by the side of 
the bed and of sufficient calibre to carry off flaky mucus. In many 
cases of dysentery of a mild form rectal irrigation will suffice, but if 
the entire colon is involved larger injections are necessary. The 
irrigation should be continued until the returning fluid becomes 
perfectly clean and free from foreign particles. If the bowel move- 
ments are very frequent, the injections may be made every three 
hours. Probably the best solution to employ for irrigation where 
much mucus and pus is present is one composed of bichloride of 
mercury, 1 : 5000. When this is used, a pure water injection or one 
of 1 : 30,000 should follow it, in order to prevent absorption of the 
mercury into the system. If for any reason the effect of the bichlor- 
ide is feared, boric acid may be used in the proportion of 1 drachm 
(4.0) to the pint (500 cc), or 15 grains (1.0) of sulphocarbolate of 
zinc added to 1 quart (1 litre) of hot water be injected. If the dys- 
entery is due to the amoeba coli large rectal injections of a solution 
of quinine in the proportion of 1 to 3000 should be used, as this drug 
destroys that organism. (See Enteroclysis in Part III.) 

Tannic acid is an intestinal antiseptic, and can be employed in 
the strength of 1 drachm to the pint (4.0 : 500 cc.) for irrigation 
purposes. 

DIARRHCEA (CHRONIC). 1 

This is one of the most obstinate conditions which the physician 
is called upon to treat. It may be due to nervous irritability of the 
bowels, so that the entrance of food or drink sets up an excessive 
peristalsis which so hurries the food and drink through the alimentary 
canal that digestion and absorption are only partly performed. Chronic 
diarrhoea may also be due to chronic intestinal catarrh, to ulcerations 
of the small or large bowels, as after typhoid fever, or to rectal dis- 
ease, which reflexly causes hyperperistalsis. Fissure of the anus often 
causes persistent diarrhoea by reflex irritation. In those cases due 
to hyperperistalsis advantage is often gained by directing the patient 
to take as little liquid as possible, particularly at meals, and to avoid 
coffee or other stimulants to reflex activity. Highly-seasoned foods 
are also to be avoided. Meats should be preferred to vegetables, and 
an absolute peptonized milk diet may be ordered, the milk being given 
in tablespoonfuls every few minutes, rather than in large amounts, at 
meal-times if the patient will remain in bed. Counter-irritation, con- 
stant and as severe as the patient can stand, should be used over the 
abdomen. Suppositories and rectal injections seldom benefit this class 
of cases, but a pill composed as follows may be useful : 

1 Head with this article those on Diarrhoea and Dysentery and Enteroclysis. 



484 DISEASES. 

R. — Argent, nitrat gr. iv (0.2). 

Ext. hyoscyam gr. x vel xxx (0.65-2.0). 

Ext. opii gr. ij vel iv (0.1-0.2).— M. 

Ft. in pil. No. xx. 
S. — One one hour before a meal. 

In other instances some of the astringent prescriptions given under 
the article on Diarrhoea are better than the above. In the cases due 
to ulcers of the rectum injections of nitrate of silver 2 grains to the 
ounce (0.1 : 32.0) are of value, particularly if followed by a 5- or 10- 
grain iodoform suppository. Operative procedure against anal fissure 
will often cure a diarrhoea due to this cause. The cases due to intes- 
tinal catarrh are benefited by the use of full doses (5 to 20 grains 
[0.3-1.3]) of bicarbonate of sodium by the mouth and the use of 
iodoform suppositories, which not only relieve the rectal irritation 
nearly always present, but exercise the peculiar effects of iodine upon 
the catarrhal process. In cases of so-called morning diarrhoea absti- 
nence from liquids before going to bed the night before and a very 
dry and small breakfast are to be strongly recommended, with rest 
in bed during the morning hours. 



DIPHTHERIA AND MEMBRANOUS CROUP. 

Diphtheria is at first a distinctly local disease, the membrane in the 
throat forming a nidus from which the entire body ultimately becomes 
filled by the poison manufactured by the micro-organism peculiar to 
the malady. The author does not believe that membranous croup 
and diphtheria are distinct diseases, but regards one as the mild or 
undeveloped form of the other. As the treatment is identical, be the 
belief of the physician what it may, the case should always be consid- 
ered as true diphtheria until it is proved to be some other disease. 

The best throat application is peroxide of hydrogen. A cotton 
swab should be soaked with the undiluted 15-volume solution and 
pressed against the mucous membrane which is diseased, or, if this 
cannot be done, a spray, from a glass atomizer, of the strength of 1 : 4 
of water may be employed. The effect is often extraordinary. After 
a few applications the false membrane appears to exist only in disor- 
ganized shreds. If the nasal chambers become affected, a solution of 
ordinary salt (7 : 1000) should be used in a spray or with a syringe, 
the child breathing through its mouth. The applications should be 
made as rapidly as the membrane forms. 

Mercury is very useful in full doses in diphtheria in sthenic per- 
sons, and the bichloride may be given by the mouth in doses of -^ 
grain (0.0013) every hour until the stools are loose or signs of ptyal- 
ism appear. Tincture of the chloride of iron, quinine, and strych- 
nine are of service to keep the kidneys active, to stimulate the heart 
and respiration, and to support the vital forces. The dose of the 
tincture of iron may be as much as 2 drops (0.1) every hour to a child 
of four years. The food of a child during an attack of diphtheria should 
be plentiful and consist of pancreatized and sterilized milk. It is best 
to use throat applications before giving the food to avoid vomiting. 



DIPHTHERIA AND MEMBRANOUS CROUP. 485 

A method of using turpentine by inhalation is highly recommended 
by J. Lewis Smith. .The following prescription is placed in water in 
the proportion of 2 tablespoonfuls (32.0) to a quart (1 litre), and this 
mixture is then placed on a gas or oil stove in a broad open vessel and 
allowed to boil constantly. The air of the sick-room is soon laden with 
the vapor, which is not "offensive. The prescription is as follows : 

R.-Acid. carbolic! ) aaf5j(32.0). 

Olei eucalypti / OJ ; 

Spt. terebinthinse fgviij (256.0).— M. 

S. — Use as directed. Label : Poison if taken internally. 

When the glands of the neck threaten to suppurate, ice-bags 
should be applied to the throat and pieces of ice held constantly 
in the mouth, while the tincture of iron is pushed in as full amounts 
as possible. 

If suffocation is imminent, inhalations of oxygen are to be used 
and atropine or strychnine employed, although tracheotomy or intu- 
bation may be necessary. 

Chlorate of potassium must never be given internally, as the kid- 
neys are already severely inflamed, and this drug is not only useless 
when so given, but is in addition a renal irritant. 

Although the author has been criticised for this last statement, he 
is convinced of its truth ; and that he is not in error is proved by 
the fact that no less eminent authorities than H. C. Wood and J. 
Lewis Smith agree with him. 

Of the extraordinary advances made in pathology and therapeutics, 
the introduction and proof of the value of antitoxin in cases of diph- 
theria is perhaps most worthy of note. Before we glance at this meth- 
od of treatment, let us understand the basis upon which it rests. It 
being universally admitted that the bacillus of diphtheria, by its local 
growth, produces toxins which, when carried in the blood or lymphat- 
ics, destroy the functional and organic life of the vital tissues, it is at 
once evident that in the body of the patient there must be two pro- 
cesses looking toward its own protection. The first is the effort at 
elimination on the part of the emunctories ; the second is a hypotheti- 
cal process — namely, that the tissues and liquids of the body contain, 
or at once manufacture, an antitoxin, the effects of which are directly 
antagonistic to the toxin of the disease. Although vital resistance 
consists in far more than this simple and single method of defence, 
it suffices at present to discuss only this part of it. If the tissues 
can form enough antitoxin to protect the organism, the patient recov- 
ers ; if they fail, either because they are feeble or because the dose 
of the toxin is overwhelming, the patient dies. In the case of dis- 
eases, such as scarlet fever and small-pox, which rarely attack the 
same person twice, it perhaps may be said that immunity is conferred 
by the tissues being trained or educated, as it were, to prepare anti- 
toxin in such large amounts when called upon that the entering wedge 
of a new attack is snapped off at the moment it begins to enter the 
field. While we rest this view of the case upon hypothesis, it fur- 
nishes us with a result which enables us to base the new treatment 
upon rational lines ; and it would seem probable that the ability to 



486 DISEASES. 

develop large amounts of antitoxin possessed by certain animals, added 
to other defensive processes, renders them practically entirely immune 
from any attack of the disease at anytime. Thus, the goat and horse 
are by nature practically immune to diphtheria, while the guinea-pig, 
on the other hand, is peculiarly susceptible. Supposing the horse 
and goat to be naturally able to resist diphtheria-inoculation to the 
extent of almost complete immunity, it becomes necessary, in order 
to make the resistance of their blood-serum absolute, to stimulate, if 
we can use such a term, their antitoxin-preparing pow T ers, and with 
this object in view injections of the toxin derived from cultures of 
diphtheria germs are made into the blood of the naturally immune 
brute. As a result, the serum of the blood of the animal possesses the 
power not only of resisting diphtheria poison while in its own vessels, 
but confers immunity of a temporary kind upon any other animal 
into whose vessels some of it is injected. It was found experi- 
mentally that antitoxic goat-serum when injected into the susceptible 
guinea-pig rendered that animal to a great exteut insusceptible to in- 
oculation by diphtheria. This is a very brief but perhaps sufficiently 
long explanation of the rationale of antitoxin treatment, which opens 
itself like a beautiful fan over many other diseases than the one we 
are discussing. As the serum coming from different cultures and 
from different horses must vary in strength, some basis for dosage or 
estimation of strength must be determined. This is done by deter- 
mining the strength of some of the culture toxin by studying its effects 
on several different susceptible animals of the same species. After 
its toxicity is determined the toxin is given to an animal, and is an- 
tagonized by the injection of antitoxin. If, therefore, an animal 
weighs 400 grammes, and it takes .001 cubic centimetre of the anti- 
toxin serum to protect it from the effects of a lethal dose of toxin, we 
can say that the strength of the antitoxin serum is as 1000 cubic cen- 
timetres is to 400 grammes, or 1 part of antitoxin to 400,000 parts 
of body- weight. We can, therefore, speak of a specimer of serum 
as of a strength of 1 : 400,000. 

The dose of antitoxin serum is to be judged, then, by its known 
strength or power of conferring immunity and by the severity of the 
disease and the susceptibility of the patient. At present the common 
dose of the ordinary antitoxin serum of Behring and Parke, Davis 
& Co. is 5 to 10 cubic centimetres, while that of the strongest serum 
is much less. The injection is to be given by means of a large syr- 
inge, which is first rendered absolutely aseptic, into the broad of the 
back, and allowed to gradually spread itself through the connective 
tissues without rubbing. 

Without giving details of the number of cases of diphtheria treated 
so far in Europe and America by the antitoxin, it may be stated that 
the gross percentage of mortality, without taking favorable cases 
alone, and including operative cases, ranges from 5 to 23 per cent., 
as against the ordinary mortality of about 50 per cent. 

The only new T local application which promises much is that of 
Loeffler. He directs that the mucous membrane shall be carefully 
wiped off by a pledget of cotton, and after this is done that a second 



DROPSY. 487 

pledget dipped in the following solution shall be pressed against the 
diseased area for ten seconds at three-hour intervals : Menthol 2 J 
drachms (10 gms.) dissolved in 9 drachms (36 c. c.) of toluol, to 
which is added 1 drachm (4 c. c.) of liquor ferri chloridi and abso- 
lute alcohol 2 ounces (60 c. c). This solution if kept in a dark 
glass bottle, well stoppered, will last for months. 

DROPSY. 

Dropsy is to be regarded as a symptom (not as a disease in itself) 
wmich may arise from many causes, such as cardiac, pulmonary, or 
renal diseases, or depend upon obstruction, from various causes, to the 
normal flow of the blood and lymph through the vessels and tissues. 
Its existence is dependent upon so many causes of a still more indirect 
nature that it is almost impossible to notice all of them, but the fol- 
lowing consideration of the subject will at least make clear some of 
the reasons fur its occurrence and indicate the means which are to be 
taken for its relief. 

At the very start we are confronted by facts which seem para- 
doxical, but which are in reality quite reconcilable. These are, that 
low arterial pressure predisposes to dropsy, and that high venous 
pressure does likewise, or, in other words, that the cause of exudation 
on one side of the circulation is its prevention on the other. 

The explanation of these statements lies in a thorough under- 
standing of the physics of the circulatory system and its anatomical 
structure. It will be remembered that dropsical exudation takes 
place from the capillaries, and that the integrity of the walls of the 
blood-vessels and lymphatics depends upon normal nutrition, or, in 
other words, upon a proper blood-supply. As a consequence, dropsy 
may be due to poorly-nourished vessels as much as to any other 
cause. Further than this, a watery state of the blood permits abnor- 
mal exudation. 

The force exercised upon the column of blood as it is driven out 
by the heart into the aorta may be considered as the chief support of 
the capillary circulation, so that if the heart be weak the pressure 
falls in the arteries, and in consequence the rapidity of flow is 
decreased in the capillaries, while, on the other hand, an increased 
cardiac activity hastens the capillary circulation. As the arterial 
pressure and force depend not only upon the heart-force, but also 
upon the tonicity of the arteries which carry the blood-stream, it 
becomes evident that dilated arteries must lower blood-pressure even 
if the heart be strong, although practically the heart and vasomotor 
system generally fail or increase in tone together. We find, there- 
fore, that a weak heart or a relaxed artery tends to cause stagnation 
of the blood in the capillaries, and, having found that such stagna- 
tion is productive of exudation, it is not hard to discover why low 
arterial pressure is a cause of dropsy. 

Having shown this to be true, let us turn to an explanation of 
the fact that a high pressure in the veins is productive of the same 
changes. 



488 DISEASES. 

Here the normal pressure is almost nothing, being much less than 
in the arteries, and considerably less than in the capillaries. The 
result of this is, that in health the blood flows rapidly from the high 
pressure of the arterv to the low pressure of the vein, and passes 
through the small veins under a gradually decreasing pressure until 
it reaches the heart. Any obstruction to this venous flow must 
increase the venous pressure, and, the venous pressure being in- 
creased, the rapidity of flow through the capillaries must be decreased. 
The whole subject may be made more clear by the following example : 

Supposing that two iron tubes are connected at one end by several 
lines of rubber tubes (the capillaries), and that water is flowing into 
the first tube, or the artery, under a pressure which is represented by 
the figure 100, while the resistance to the flow in the second tube, 
the vein, is represented by the figure 0. It at once becomes evident 
that the rapidity of the flow through the connecting rubber tubes 
will be very great, whereas if the pressure in the first or arterial 
tube is decreased to 50, the rapidity is decreased to one-half, or if the 
pressure in the second tube be increased to 50 instead of remaining 
at 0, the same changes will occur ; in either instance capillary flow is 
lessened and exudation is caused. This is the pathology of dropsy, 
and, having understood it, let us proceed to discover the causes of 
dropsy in various diseases. 

In cardiac disease it is due to a weak heart being unable to supply 
the arteries with enough blood to maintain the normal pressure, or to 
a damming-up of blood in the venous system as the result of the 
imperfect emptying of the cardiac cavities. In the first instance low 
arterial pressure produces dropsy ; in the second, high venous pressure 
has a similar effect. 1 

In renal troubles the dropsy depends more upon the lack of proper 
nutritive processes in the capillary walls and upon changes in the 
blood-pressure than upon other causes. If the kidney is diseased, it 
may not be able to eliminate the proper quantity of liquids, which 
accumulate and finally escape into the tissues, while the same failure 
in renal function causes disease of the blood-paths themselves, and 
often produces cardiac complications. 

Hepatic troubles cause dropsy by producing pressure upon the large 
blood-vessels going to the liver, and, in consequence, the exudation is 
generally confined to the lower limbs and abdomen. If the hepatic 
trouble be severe, some failure in the nutrition of the blood-vessels 
and changes in the quality of the blood may ensue. 

Pulmonary disease rarely causes dropsy unless the venous pressure 
is greatly increased and productive of cardiac dilatation, or, as in 
phthisis, where the changes in the nutrition of the body involve the 
blood-vessel walls and the blood. 

Having spoken of these causes of dropsy, it remains for us to con- 
sider its treatment, which may be divided into two parts — namely, 
that directed to its removal when once the liquid is poured out, and 
its relief or cure by direct attention to its causes. The means for the 

1 For an explanation of these changes in the action of the muscle, valves, and Car- 
oline action in heart disease see the article on Heart Disease. 



DROPSY. 489 

removal of the fluid are suitable to all cases, be the cause what it may, 
unless the dropsy be of renal origin. Whenever an accumulation of 
liquid takes place in the tissues, drugs or measures must be resorted 
to which will cause the emunctories of the body to get rid of it. In 
ascites, in particular, we may employ elaterium in the dose of -J- of a 
grain (0.01), or elaterin in the dose of 2V of a grain (0.003). placed 
in the mouth and washed down by a little water, or, if this is not 
used, the compound jalap powder may be resorted to in the dose of 
20 to 30 grains (1.3-2.0), and to it may be added, to increase its 
efficiency, 10 grains (0.65) more of bitartrate of potassium than the 
official powder contains. These two remedies are particularly ser- 
viceable in renal dropsies, since the elaterium is supposed to aid in 
the elimination of urea by the bowel, while the cream of tartar in the 
jalap powder increases the action of the kidne} T s. 

The cream of tartar is not to be used in cases of acute nephritis. 

Compound extract of colocynth may be employed in the dose of 
2 to 6 grains (0.1-0.3), according to the state and idiosyncrasy of the 
patient. 

All these remedies relieve dropsy by causing so great an outpour- 
ing of liquid from the blood-vessels of the intestine that the liquids in 
the tissues are taken up by the depleted blood-vessels to replace the 
loss through the action of the purgative. In other words, these 
purgatives render the alkalinity of the blood greater by concentra- 
tion, and absorption of fluid occurs by reason of the following physio- 
logical and physical facts : 

As is well known to every physiologist, the passage through a 
blood-vessel of a salt solution of less than T 7 7 of 1 per cent, causes an 
abstraction of salts from the surrounding tissues by the circulating 
fluid, in order that the amount of salts in the vessels and tissues may 
be identical. At the same time the tissues become infiltrated with 
liquid. On the other hand, if the solution be stronger than the 
normal, the liquid leaves the tissues to enter the vessels, and the 
tissues in consequence shrink. 

When salines are given to relieve dropsy, they must be admin- 
istered in concentrated or saturated solution and on an empty stom- 
ach, total abstinence from the drinking of water being insisted upon 
until they have fully acted, for the reasons given in the last para- 
graph. For this reason they should be given an hour or so before 
breakfast. If these directions are not followed, this method of treat- 
ment is useless. 

The other means which we possess for the removal of dropsy are 
by way of the kidneys and skin. If the kidneys are hopelessly dis- 
eased, that pathway is almost useless, but if they are only passive or 
partly inactive, diuretics may be used to stimulate their secreting 
structure and to increase the leakage of liquid through them by 
increasing blood-pressure. Such patients should be placed almost 
entirely on a milk diet, and many of them will greatly improve under 
the use of buttermilk to the exclusion of other nourishment. If this 
cannot be taken, sugar of milk maybe employed as an active diuretic. 
(See Sugar of Milk.) 



490 DISEASES. 

Often the kidney will be found inactive, because, owing to conges- 
tion from cardiac trouble, it cannot act. Under these circumstances 
digitalis, in 5- or 10-drop (0.35-0.65) doses of the tincture, given 
three times a day, will be of value, and its efficacy will be increased 
by the addition of 1 drop (0.05) of the tincture of cantharides if the 
renal lesion is exceedingly chronic or mere torpidity exists. Digitalis 
and squill, in pill form, as follows, may be used : 

R.—Pulv. digital, fol gr. xx (1.3). 

Pnlv. scillas gr. xx (1.3).— M. 

Ft. in pil. No. xx. 
S.— One every five hours. 

Or digitalis and calomel may be employed in pill form in renal and 
cardiac dropsies. 

Caffeine is also a useful diuretic, particularly in torpidity of the 
kidney, as it stimulates the secretory epithelium, thus eliminating urea 
and other effete matters, and increases the passage of liquids by the 
increased blood-pressure which it produces. 

That a large amount of liquid may be gotten rid of through the 
skin under the influence of heat is well knoivn. (See Heat.) In 
addition to external heat we may use pilocarpine by the mouth or 
hypodermically in localized dropsies, to produce absorption and con- 
sequent elimination of liquid by sweating. No drug should ever be 
given hypodermically in dropsy of a general character, as it will not 
be absorbed from the water-soaked tissues with any rapidity, if at all. 

The chief means of relief to be resorted to in cases of ascites is tap- 
ping. Efforts to remove effusions in the peritoneal cavity by medicinal 
measures are rarely followed by success. In reality, tapping is far 
less heroic treatment than purgation, and the old theory that it is dan- 
gerous has been completely disproved. It has been found that tap- 
ping not only removes the fluid, but may in some unknown manner 
produce a permanent cure after from one to twenty or more operations. 
In performing tapping the patient is to be placed in a sitting or semi- 
recumbent position, and directed to evacuate his bladder, so that there 
will be no danger of this viscus being injured by the trocar. The 
skin of the abdomen in the middle line one or two inches below the 
umbilicus is next benumbed by salt and ice held against it. The 
physician then takes a trocar and canula, at least four inches long, 
and pushes it through the abdominal wall until by the decrease in 
resistance he knows its point has entered the abdominal cavity. It is 
well to have a broad abdominal bandage placed around the belly, so 
that an assistant by pulling on its ends may support the belly-walls 
when relaxed by the escape of the effusion. As a rule, not more than 
one-half or three-fourths of the liquid should be removed at one sit- 
ting, as its entire removal may be followed by collapse. The value 
of iodide of potassium in cases of ascites is not to be forgotten, but 
it must be given cautiously if renal disease is present. 

Where the tenseness of the skin in the lower extremities causes 
danger of local sloughs, some authors recommend small punctures for 
the escape of the liquid, the limbs being encased in sterilized absorb- 
ent cotton to absorb the liquid. (See Acupuncture.) 



DYSMENORRHEA. 491 

DYSENTERY. 
(See DlARRHGEA.) 

DYSMENORRHCEA. 

The existence of dysmenorrhcea depends upon so many conditions 
that the treatment employed in one case is seldom productive of suc- 
cess in the next. This is not the place for a consideration of the 
surgical measures adopted for the cure of this symptom, and only the 
medical treatment will be spoken of. 

When dysmenorrhcea results from the taking of a cold, and is 
accompanied by uterine congestion and irritability, the following 
measures are particularly valuable, and may do good in many cases 
depending upon other causes: The patient should take a hot sitz- 
bath, and immediately get into bed as soon as the buttocks are dried, 
being well covered while in the tub and afterward by a blanket. A 
turpentine stupe is now to be used (see Turpentine), and 10 grains 
(0.65) of Dover's powder to be administered, unless some idiosyncrasy 
toward opium is known to exist, when a half or a fourth of this 
amount may be employed. Often when the attack is accompanied by 
constipation a purgative dose of Epsom salts or aloes is of service in 
the congestive forms of the disorder. 

If the pain is persistent and severe, a belladonna suppository, of 
\ grain of the extract, may be inserted into the rectum, or in other 
cases belladonna ointment smeared over the os uteri will be found of 
service. The latter method is generally impracticable and is rarely 
resorted to. Very commonly belladonna tincture, by the mouth, is 
of service in relaxing the spasm of the cervix and of the uterine 
fundus. 

Some practitioners resort to the use of opium at each epoch, and 
keep the patient partially narcotized until menstruation is passed. 
This is unjustifiable and born of ignorance and bad practice, since 
the physician is simply dodging the trouble and predisposing the 
patient to future attacks by reason of the constipation and the result- 
ing habit which is almost sure to appear after the repeated employ- 
ment of opiates. 

When the dysmenorrhcea is due to obstruction of the cervical canal 
by organic changes or flexions, these conditions must, of course, be 
relieved before a cure can be expected, and the medical treatment 
can be directed only to the alleviation of the pain. Divulsions or slow 
or rapid cervical dilatation should be carried out by the use of instru- 
ments or tents. 

In neuralgic dysmenorrhcea, dependent rather upon nervous dis- 
order accompanying menstruation than upon menstruation itself, 
measures directed to the improvement of the nervous system and the 
nutrition of the patient are necessary. These cases generally occur 
in nervous, anaemic women run down by excessive dancing or other 
gayety or by the bearing and care of a large family of children. 

A course of strychnine or quinine and iron in small doses is often. 



492 DISEASES. 

beneficial in these cases, and horseback exercise between the men- 
strual periods, out-of-door life, and avoidance of excessive dancing 
and exhausting exercise are to be ordered. 

Sometimes bathing the loins with alternate dashes of hot and cold 
water may do good -in atonic patients. 

Cannabis indica and gelsemiiim are often of great service, both as 
cures and alleviators of the pain, and antipyrine, acetanilid, and 
similar drugs may be resorted to while the attack lasts, if it be 
neuralgic. 

When the pain seems to be greater than the patient can bear, 
enough ether or bromide of ethyl should be given by the physician, by 
means of inhalation, to produce the primary stages of anaesthesia, but 
chloroform is not advisable, as the patient, if taught its value by the 
doctor, may resort to it without advice and die from an overdose. 



DYSPEPSIA. 

(See Indigestion.) 

DYSPNCEA. 

Shortness of breath, or dyspnoea, arises from cardiac weakness, 
abnormal innervation resulting in cardiac palpitation, from the accu- 
mulation of fluids in the chest, from the involvement of the lungs by 
any disease-process in such a way that respiration becomes impaired, 
or it is produced by indigestion, or, finally, by the encroachment on 
the lungs or chest-walls of tumors and growths. 

Each of these states must be removed to effect a cure, but it is only 
of the relief of the symptoms that we will speak. 

In old persons who suffer from dyspnoea the result of bronchor- 
rhoea, where a large amount of liquid fills the bronchial tubes and 
shortness of breath follows exertion, strychnine is the best remedy 
that we have. Its value depends upon its powerful influence over 
the respiratory centres, on which it acts as a stimulant ; and as these 
cases very commonly also have dilatation of the right side of the 
heart, with consequent cardiac enfeeblement, strychnine is of addi- 
tional service through its influence upon the circulation. These per- 
sons are not to be given opium or its alkaloids or any sedative drugs, 
as such medicines, while giving temporary relief from cough, only 
serve to depress the respiratory apparatus and cause an accumulation 
of liquid mucus in the chest as a result of the prevention of cough 
and lack of expectoration. The cases in which opium or morphine 
do good are those in which, through nervousness or functional nervous 
disorder, the respiratory cycle is imperfect, and, above all, in those 
instances where dyspnoea occurs as the result of cardiac disease. In 
these cases the attacks of oppression and suffocation can often be 
entirely set aside by the use of J to J grain (0.008-0.015) of mor- 
phine, given every night or at night and morning. If these doses fail, 



EARACHE. 493 

larger ones may be cautiously used. Hyoscine, instead of causing 
sleep, nearly always makes these cases worse. 

Sometimes a little carbonate of ammonium is useful as a respira- 
tory and cardiac stimulant in cases of dyspnoea. 

Dry cupping applied over the back of the chest may also be ser- 
viceable when shortness of breath from cardiac or pulmonary trouble 
is present. 

In cases of dyspnoea due to emphysema and pulmonary inflamma- 
tion of a chronic type, or in those persons who take cold on the 
slightest exposure, particularly after attacks of asthma, arsenic is 
useful if continuously employed. 

If pleural effusion be present, relief of a positive and lasting nature 
can only be obtained through aspiration, or, in other words, by the 
operation known as thoracentesis. 

EARACHE. 

Earache may arise from a great number of causes, all of which 
are, practically speaking, inflammatory. The pain may be the result 
of acute chronic inflammation of the middle ear, with a serous or 
purulent exudate, or to furunculosis of the external auditory canal. 
In other cases an eczema of this part is very painful. The treatment 
is systemic and local, the former being based on the general rules 
governing the management of inflammatory processes, the latter by 
the area involved and the cause of the trouble. In the general treat- 
ment a leech may be placed in front or behind the ear, and heat is to 
be applied to the head on the side affected in a dry form by means of 
a hot bottle or water-bag. Poultices, oil, and laudanum, and similar 
applications are not to be resorted to, as they may ultimately cause 
trouble and do not always produce even temporary relief. 

Sometimes dropping a little water, as hot as can be borne, into the 
external auditory canal gives great relief if repeated as fast as the 
w T ater cools. 

Cardiac sedatives are indicated, but quinine is distinctly contrain- 
dicated, as it tends to cause aural inflammation. 

If a cold in the head is present, and with it acute myringitis, it is 
important to establish a free opening through the nostrils, particularly 
if the middle ear is also involved, in order to clear the orifice of the 
Eustachian tube. This is to be accomplished by dropping into each 
nostril 1 to 3 drops (0.05-0.15) of a 4 per cent, solution of cocaine, and, 
as soon as the engorged mucous membrane is anaesthetic and shrunken, 
to use an atomizer with a fine spray attachment and the following 
solution : 

R.— Acid, boric gr. x (0.65). 

Sodii chlorid gr. xij (0.8). 

Sodii borat gr. x (0.65). 

Aq. rosse q. s. ad f^iij (96.0). — M. 

S. — Use as a spray. 

This should be followed by a spray of menthol and albolene, 3 grains 
to the ounce (0.15 : 32.0), in order that the menthol may prolong the 



494 DISEASES. 

effect of the cocaine and prevent secondary congestion. This is now 
to be followed by inflation of the Eustachian tube with a Politzer's 
air-bag. Only in most obstinately painful cases of acute middle-ear 
catarrh is paracentesis of the drum to be attempted. Should true 
septic otitis media develop and drainage of the middle ear become impos- 
sible through blocking of the Eustachian tube, then the doctor must 
very gently irrigate the external auditory canal with as hot water as 
can be borne, and render it entirely aseptic by insufflations of boric- 
acid powder. These injections should be frequently practised, and 
if the pain persists and the tympanic membrane is bulging, para- 
centesis must be performed in the most bulging part of the lower 
quadrant. After the paracentesis needle is withdrawn the discharge 
should be allowed to flow freely, and then boric acid be once more 
dusted into the ear and a piece of cotton inserted. 

In the case of eczema of the ear hot irrigation, followed by pow- 
dered iodoform, is perhaps the best application for temporary treat- 
ment. In furunculosis of the ear hot irrigation and free incision, with 
iodoform dressing, are also useful. 

When foreign bodies cause the pain, they are best removed by 
repeated and gentle syringing with hot water. Forceps are danger- 
ous instruments in the hands of a novice treating the ear. 

In earache due to neuralgia a swab of chloroform may be applied 
in front and behind the ear. 



ECZEMA. 

This is probably the most common form of skin disease which the 
physician is called upon to treat, with the exception of acne. 

Dermatologists divide it into many forms and stages, but in this 
book a consideration of its forms is out of place, and only the treat- 
ment for its stages is proper. 

In the first place, it may be stated that the treatment is a quad- 
ruple one — namely, dietetic, hygienic, external, and internal. 

In regard to diet, the patient should be told to avoid salt foods, 
such as salt fish or pork and corned beef; greasy foods, such as bacon 
and fried dishes ; pastry and cheese. Only moderate amounts of wine 
and beer can be taken, and foods difficult of digestion are to be 
stricken off the bill of fare. 

In the way of hygienic measures, fresh air, the avoidance of seden- 
tary habits, horseback exercise, or walking are to be recommended. 

External treatment is the most important of the two measures in 
which drugs are employed, and its course is perhaps best described 
by taking a case of ordinary eczema as an example and treating it 
through its entire course. 

In the early stages of an acute eczema, when the process is very 
active and the erythematous reddening of the beginning of the dis- 
ease is merging into the formation of vesicles or pustules, with the 
formation of large scabs, no application is better than oxide-of-zinc 
ointment, thoroughly applied night and morning. If the eczema be 



ECZEMA. 495 

situated upon the scalp, the hair must be invariably clipped short or 
shaved off in such a way as to prevent the gluing of the hair into a 
mat by reason of the discharge. The ointment may be smeared over 
the part or applied on a piece of lint in a thick layer. Nearly always 
the ointment should be used in conjunction with black wash (calomel 
1 drachm [4.0], lime-water 1 pint [500.0]), which should be applied 
twice a day, just before the zinc ointment is resorted to, by means of 
a swab or a sop, and allowed to dry. In other cases the powdered 
oxide of zinc is dusted over the part if the discharge is very watery 
and profuse, or the following ointment, recommended by McCall 
Anderson, is very efficacious : 

R.— Bismuth, oxidi |j (32.0). 

Acid, oleic, pur ...... ^viij (256.0). 

Cerse albse §iij (96.0). 

Petrolati ^ix (288.0). 

Olei rosfe TT\,v (0.3).— M. 

Ft. in unguent. 
S. — Apply to the part affected. 

As the quantities of this prescription are large, they may be 
reduced one-half for use in limited eczema. 

Where the proliferation of cells and the secretion are very profuse 
it may become necessary to remove the crusts before the local rem- 
edies can reach the skin, and for this purpose poultices may be used ; 
or, if the disease be on the face, the parts should be anointed with 
olive oil, containing 1 or 2 drops of carbolic acid to the ounce (0.05- 
0.1 : 32.0), to soften the crusts, which are readily removed in a 
half-hour by the use of a little castile soap and water. The soap is 
not to be used if the inflammatory action is very angry-looking. 
Whenever itching is an annoying factor, the parts should be protected 
by lint smeared with some simple ointment, which may be carbolized 
both for its antiseptic and local anaesthetic effect. English and Amer- 
ican dermatologists use what is known as liquor carbonis detergens 
very largely in the acute stages of eczema as well as in other skin 
diseases. It should not be used pure, but diluted in such a way that 
for each 4 ounces (128.0) of water 2 drachms (8.0) of the pure liquor 
are present. Liquor carbonis detergens is made by taking 9 ounces 
(288.0) of tincture of soap-bark (quillaia-bark) and 4 ounces (128.0) 
of coal-tar, mixing and allowing them to digest for eight days, after 
which the mixture is filtered and used. 

When the disease has passed from the acute, active inflammation 
of the first stage to the subacute form of the second stage of its exist- 
ence, applications of a mildly stimulant character are necessary. 
Before this the physician has endeavored to soothe the parts ; now 
they must be excited to normal activity. For this purpose resorcin 
in the proportion of 2 to 30 grains to the ounce (0.1-2.0 : 32.0) of 
lard, according to the severity and induration of the lesion in the 
skin, should be used. Stelwagon recommends the following : 

R. — Unguent, picis liq £j (4.0). 

Unguent, zinci oxidi 3vij (28.0). — M. 

S. — Apply to the parts. 



496 DISEASES. 

Where the disease is chronic and very persistent, but sluggish or 
atonic in its course, still more powerful remedies are necessary, such 
as salicylic acid, tar, or tincture of green soap used with hot water 
until the skin beneath is bared, dressing this by means of zinc oint- 
ment or resorcin ointment, 2 to 10 grains to the ounce (0.1-0.65 : 
32.0), spread on a cloth. The salicylic acid should be used in the 
proportion of 30 to 60 grains to the ounce (2.0-4.0 : 32.0) of lard, 
while the tar is used in the form of the pure official tar ointment. 

In seborrhceic eczema, where the secretion is greasy and dry, and 
followed, if wrongly treated, by oozing and the pouring out of serum 
and the formation of cells which form crusts, the following prescrip- 
tion is of value : 

R . — Kesorcin gr. x vel xx (0.65-1.3). 

Pulv. amyli 1 -- „,.. /0 m 

TT , J . . . ,. v . . . . aa £11 (8.0). 

Unguent, zinci oxidi J ° J v 

Petrolati gss (16.0).— M. 

S. — To be applied after removing the scabs by the use of a lotion composed of 1 

part of bay rum and 3 parts of water. 

The internal treatment is directed to the cure of any disordered 
function which is present, such as dyspepsia (see Indigestion), hepatic 
torpor, general debility, anaemia, scrofulosis, inanition, constipation, 
gouty diathesis, or renal insufficiency. The gastric disorder is to be 
relieved by the use of hydrochloric acid and pepsin ; the hepatic tor- 
por by mercury, podophyllin, or, better still, by freshly-prepared 
undiluted nitro-hydrochloric acid added to water ; the debility by 
tonics, such as cinchona, cod-liver oil, strychnine, and bitters ; the 
anaemia by iron, and, if scrofulosis exists, by the syrup of the iodide 
of iron. Constipation is to be cured by the use of proper foods and 
laxatives, and the gouty tendency counteracted by the employment 
of lithium citrate and colchicum or potassium iodide. If the kidneys 
are at fault because of torpidity, the diuretic potassium salts, such as 
the citrate, are indicated. Arsenic is never to be used, except in 
those instances where the skin is very dry, and where, by improving 
digestion and through its alterative power, it does good. In the 
chronic forms of dry eczema or those depending upon some atonic 
state of the trophic nerves of the skin, arsenic is of great value in 
the form of Fowler's solution, or arsenous acid may be given. 



EMISSIONS. 

Seminal emissions occur as the result of sexual abuse, whereby a 
condition of hyperexcitation of the nervous cells in the spinal cord 
and the nerves of the genitalia is developed, or they are due to 
peripheral or centric irritations, which reflexly irritate the genitalia 
or the nerves, and to a number of other similar causes. These emis- 
sions also occur with some periodicity in normal males who are con- 
tinent and chaste, and under these circumstances are not to be inter- 
fered with by treatment, unless the emissions become excessive. 

The former types are, however, proper for medical treatment, and 



ENDOCARDITIS. 497 

their cure consists in the avoidance of unchaste literature and lasciv- 
ious thoughts during the waking hours, and the use of such spinal and 
cerebral sedatives that the centres governing the ejaculations of semen 
may be calmed, and so quiet a sleep produced that erotic dreams are 
avoided. The patient should sleep on a hard hair mattress, not be too 
heavily covered, and should avoid sleeping on his back, as this causes 
an undue blood-supply to the spinal centres, and consequent stimula- 
tion and ejaculations. Sometimes hard bodies, such as spools, are tied 
around the loins, so that lying on the back will cause so much discom- 
fort that the patient awakes and turns on his side. The drugs to be 
used are bromide of potassium or sodium in 20-grain (1.3) doses at bed- 
time, or chloral may be taken in the same amount. Hyoscine is cer- 
tainly of value in the dose of y-j-^- grain (0.0006). Sometimes a warm 
sitz-bath or general bath before going to bed is of service. In other 
cases, where atony is the cause of the trouble, the physician should 
recommend cold sponging of the perineum and loins night and 
morning. 

In the cases in which emissions come on as the result of continence, 
and become excessive, the remedies just named are to be tried, but 
really do not effect any permanent cure unless used until sexual power 
is seriously depressed, so that it has been the custom of many physi- 
cians to recommend "marriage," which the patient may interpret in 
its legitimate light or not as he pleases. 

It is worthy of note that all irritations of the urinary bladder and 
other parts of the genitourinary system should be removed, and it is 
often of value to administer citrate of potassium in 20-grain (1.3) 
doses, in water, three times a day, to render the urine non-irritating 
and alkaline. Stimulating foods and drinks are to be interdicted, and 
condiments, such as pepper and mustard, avoided. 

Sometimes, w r hen the emissions are caused by genital atony, strych- 
nine and arsenic are of very great service if given in full dose. 

In many of these cases it is the duty of the physician to treat the 
moral state of his patient as well as to give medicines. Many per- 
sons, believing that emissions are always an evidence of disease, read 
books on such subjects which are sold by quacks and soon find their 
way to the hands of these persons, or sensibly consult a regular physi- 
cian. Half the treatment in these instances consists in assuring the 
patient that he has nothing to worry about, and in making him feel 
that the physician is his friend and worthy of all confidence and 
complete belief. 



ENDOCARDITIS. 

Endocarditis occurs sometimes as a single manifestation of disease ; 
sometimes as a symptom, with many others, of some general tendency 
produced by a diathesis, such as gout and rheumatism or syphilis. 
Further than this, it may be acute, subacute, or chronic, and each one 
of its forms must be differently treated. 

It is hardly necessary to state that any diathetic taint should be 

32 



498 DISEASES. 

treated by antirheumatic or antilithic remedies, such as the iodides. 
The iodides are not, however, indicated if any rapid changes of a 
degenerative type are at work. In acute sthenic endocarditis, asso- 
ciated with great vascular disturbance and much cardiac embarrass- 
ment or irregularity, there is no remedy half so good in the early 
stages as full doses of tincture of aconite, 2 to 3 drops (0.1-0.15), 
given every hour until the physiological symptoms of its influence are 
felt, or, in its place, with equal efficacy may be employed the tincture 
of veratrum viride (2 to 3 drops [0.1-0.15]). At the same time cal- 
omel and opium may be used, the calomel for its antiphlogistic influ- 
ence, and the opium to control the purgative tendencies of the mer- 
curial. Thus we may use J grain (0.015) of calomel every two hours 
and y 1 ^ (0.006) of morphine. Leeches should be placed over the 
prsecordium in a goodly number, and if these are not obtainable wet 
cups are to be employed, In some cases it is wise to apply an ice- 
bag over the heart. This depletion is only of service when the dis- 
ease is seen early enough to make its abortion possible. As . the 
disease progresses, if the physician fails to' stop it, it will be found 
that the heart becomes somewhat labored in its action, irregular, and 
weak, and that its rhythm is seriously interfered with. At this time 
digitalis is of use in stimulating the depressed cardiac muscle and 
increasing its reflex activity, also steadying it through the pneumo- 
gastric irritation which it produces. Aconite and other depressants 
are contraindicated at this time. Absolute rest upon the back is to 
be insisted upon, and it is recommended, in those cases where deposits 
of a calcareous nature are likely to occur in the valve, that the citrate 
or acetate of potassium be given or that citrate of lithium be employed. 
If the disease becomes ulcerative, supporting treatment, consisting 
chiefly in the use of good food and the tincture of the chloride of 
iron is of great value if the dose which is given is large. 



EPILEPSY. 

The disease known as epilepsy is probably the most disheartening 
condition as to treatment that the physician has to deal with, since it 
often resists the influences of all the standard remedies, and drives the 
practitioner from drug to drug in the hope of finding one which will be 
at least alleviating in its effects. For this reason the author has in this 
instance included the drugs which are rarely used, as well as those 
generally recognized as useful in its treatment, in order that the 
physician may try every remedy of any possible value. 

It should be borne in mind that the treatment of epilepsy is as 
various as the disease is variable in its forms and phases, and should, 
in nearly all cases, resolve itself into two or perhaps three divisions, 
consisting in the removal of any exciting cause, in the checking of 
the convulsive tendency already set up, and in the prevention of any 
further attacks by suitable drugs or other measures of relief. 

The treatment is governed largely by the cause, and is medicinal 
or-operative according to the etiological factors at work. In simple 



EPILEPSY. 499 

idiopathic epilepsy medicinal means must be followed, while in a case 
resulting from traumatism the depressed bone, abscess, or tumor must 
be removed, and in those due to reflex irritation the peripheral source 
of trouble must be sought out and relieved. 

So far as drugs, are concerned, the most valuable remedy in use 
for the relief of epilepsy is bromide of potassium, although other 
forms of bromide salts are to be mentioned later on. 

This drug, however, is not a k ' cure-all," even in epilepsy, and 
reports are constantly made of cases where it has failed ; but many 
cases prove that the remedy is undoubtedly responsible for a cure 
when it is pushed in a suitable manner, and in the vast majority 
of instances the seizures are so decreased, both in violence and fre- 
quency, that its use may be said to be indicated in every case of the 
disease. 

In a very small minority, however, it signally fails, and in a still 
smaller number of cases it is useless unless combined with some other 
drug whose power alone is very slight. Nevertheless, it is to be laid 
down as a rule that the bromide treatment of epilepsy is, par excellence, 
the treatment to be employed on every occasion. There is no other 
drug known which can be relied upon so absolutely, or which is so 
powerful in its action and devoid of marked toxic effect unless given 
in enormous doses. 

The doses to be used vary with the salt employed to a considerable 
extent, and depend upon the character of the disease and the tem- 
perament and physique of the patient. The greater the duration of 
the disease, the greater is the difficulty in effecting a cure, and the 
length of time which the man has been epileptic should therefore be 
most carefully reckoned before the treatment begins. Further than 
this, the frequency and severity of the attacks are to be looked into, 
and these points are really more important than the actual duration 
of the ailment ; since if a man has only one fit every six months for 
twenty years his condition is far less serious than if he has a history 
of three or four fits a day for one year. Again, the character of the 
attack, as to its violence, may be the most important fact to be re- 
garded, for if it is violent enough to endanger life, remedies must be 
pushed even beyond the point of tolerance. The writer has heard 
a very celebrated physician cause much amusement among his auditors 
by detailing an instance of an epileptic who was getting well, and 
would have recovered if he had not died. His explanation was, that 
the man was syphilitic, and was receiving moderate doses of iodide 
and bromide of potassium, which were slowly benefiting him, and 
would have cured him had not a single severe fit produced death in 
the mean while. Another point to be considered is the condition of 
the digestion, which the bromide of potassium is peculiarly liable to 
disorder, and which is sometimes so disturbed as to necessitate the 
administration of the drug by the rectum in serious cases. Females 
generally require smaller doses than males, and children of both sexes 
do not require as large quantities as adults. The dose to be used in 
the beginning of the treatment in moderate cases is about 10 grains 
(0.65) thrice a day ; and while this may seem a very small quantity, 



500 DISEASES. 

it will be found that it can be rapidly increased in amount without 
causing the gastric distress produced by the sudden use of larger 
doses. Each day an additional 10 grains may be added, until at the 
end of a week the patient is taking 80 grains (5.3) in each twenty- 
four hours. There are very few cases which will not become com- 
pletely saturated with the drug if this is done, and there are very few 
in which a more rapid arrival at bromism is needed. If, however, the 
patient has become able to stand large amounts by the prolonged use 
of the drug, the amount given is not to be governed by grains, but by 
physiological effects, and it may be pushed to any amount which is 
borne without distress. 

In chronic epilepsy, too, with regularly recurring fits, the greatest 
good is obtained by pushing the drug in ascending doses for one week, 
and then for the succeeding week only enough is given to preserve 
the general effects of the medicament. By doing this the stomach 
gets a rest and the appetite is not greatly interfered with. Where 
the attacks occur only every two weeks, this is a particularly useful 
method for obvious reasons. As regards the time of day when the 
drug is to be taken, there can be no doubt. Some writers have 
directed that it shall always be taken before meals, but this is entirely 
lacking in advantage and decidedly fruitful of harm. Medicines 
which are given with the object of affecting the general system should 
be taken after meals, not before, and it is only when a local gastric 
effect is desired that we use them on an empty stomach, particularly 
when the substance is as irritant and depressing as potassium. If 
taken after meals the appetite is not decreased, but there are few who 
can take a dose of 10 or 20 grains (0.65-1.3) of bromide of potas- 
sium before breakfast without suffering from indigestion. It has been 
held by some that the drug should be taken in minute doses, fre- 
quently repeated, in order to keep the patient constant! j- under its 
influence. This is an example of therapeutic ignorance, because 
bromides are slowly eliminated, and this frequent administration pos- 
sesses the disadvantages of being inconvenient, annoying, and apt to 
disorder the stomach. 

If the attacks have a distinct periodicity or can be foretold for as 
much as two hours beforehand, the remedy may be taken in a large 
dose only at this time, and but a few grains given in the intervals ; 
and if the attacks are severe, no one should hesitate to use large doses 
by the mouth and by the rectum on the day of the attack. 

A very important point to be borne in mind is that the drug often 
seems to have produced a complete cure, and this results in careless- 
ness in the regularity of administration. The patient should be 
impressed by the fact that every day passed without a fit is a step 
forward, and that every fit carries him many steps backward. He 
should also be made to use the drug, in moderation, for at least three 
years after all fits have ceased, and to watch after that time for the 
slightest sign of their return. The quantity taken each day should 
be gradually decreased, not suddenly stopped short. 

It is true also that if a recurrence of the fits takes place they yield 
to treatment very much more slowly than before. 



EPILEPSY. 501 

Before passing on to the discussion of the other bromides, and the 
conditions produced by the excessive use of all of them, we may 
place our use of these compounds in epilepsy on a scientific footing. 
It is now generally recognized that the seizures known as epilepsy 
arise from the cells in the cerebral cortex, and there can be no doubt 
that the bromides act very powerfully upon the cerebrum in the 
higher animals, decreasing the irritability of the motor centres in 
these regions to a very great extent. Not only is this pointed to by 
clinical facts, but the well-known researches of Albertoni prove that 
such is their action beyond all doubt. This investigator found that 
the administration of a single dose of the bromide of potassium so 
lessened the excitability of the motor cells in the cortex cerebri that 
much stronger stimulation was necessary in order to cause response 
in the limbs than was normal, and that it was difficult to produce 
epileptic attacks by means of the electrical stimulation of the motor 
areas, even when currents very much stronger than those which com- 
monly produce such a result were used. He also found that this 
lessened irritability was increased still further if the drug was given 
for several days beforehand in such doses as thoroughly to impress the 
organism. It is therefore evident that the bromides act directly on 
the cortical areas, calming the tendency to explosions of nerve-force. 

The results of Seppilli have also confirmed those of Albertoni in 
every way. 

An enormous amount of research has also proved that the drug 
may be doubly useful in reflex epilepsies, not only by its action on 
the motor portion of the cortex, but by its influence on the afferent 
portion of the nervous system. 

The experiments of Eulenberg and Gutmann prove that the sen- 
sory paths in the spinal cord feel more powerfully than any other 
portion of the body the effects of the drug ; for these investigators 
found that if they tied the blood-vessels supplying one limb of an 
animal, reflex action was abolished equally on both sides, proving 
that the loss of reflex action does not depend upon the action of the 
drug on the sensory nerve-trunks. That the loss of reflex activity is 
not due to an action on the motor portion of the cord is proved by 
the fact that voluntary motion is completely preserved. As these 
experiments have been confirmed by LeAvisky, Bartholow, Purser, the 
author, and Laborde, there can be no doubt of their truth ; and we 
can rest assured that not only does the drug prevent nervous dis- 
turbance in the cerebrum, but also that it prevents the peripheral 
irritation from travelling up to the brain, there to produce morbid 
excitement. 

Apropos of the theory that epilepsy is due to vasomotor disturbance, 
which is unfounded, it may also be added that the bromide of potas- 
sium was and is believed by some to effect a cure by producing a vaso- 
motor spasm at the base of the brain, but there is no basis for this 
idea, even if the disease were due to vasomotor changes. Hammond 
and Amory have seen the circulation in the brain slowed by the drug, 
and it has been claimed by Lewisky that if the toes of a frog be cut 
off, the blood flows more slowly from them in the poisoned animal 



502 DISEASES. 

than in the normal frog. None of these facts prove vasomotor action, 
but rather that there is a lessened circulation by reason of the cardiac 
depression produced by the potassium, for this element is known to 
have this influence. 

An important therapeutic point is to know how rapidly bromide 
of potassium is eliminated, so that we may know how frequently to 
give the drug. 

That it passes out of the body with only moderate speed is certain, 
for Rabuteau has noted its presence in the urine one month after the 
last dose, and Bill has found it in the same secretion two weeks after 
the use of the drug had ceased. 

Amory recovered, on the other hand, one-half the amount ingested 
in the first succeeding twenty-four hours, and one-third in the second 
twenty-four hours. It is evident, however, that it is eliminated so 
slowly that doses given three times a day make the patient ingest 
more than he eliminates. That bromide of potassium remains a long 
time in the system is proved by the fact that after repeated doses given 
to a healthy man marked somnolence persists for some days. 

There is one more point to which attention must be called, and that 
is the fact that when the bromides are taken for any length of time 
they produce bromism, which in its moderate or severe forms produces 
a mental condition very closely allied to that seen in old, chronic epi- 
leptics. This condition of the mind should never be overlooked, and 
the ordinary mental changes of epilepsy are greatly increased by its 
constant and careless administration. 

The bromide salts of gold, iron, sodium, lithium, nickel, and 
ammonium have all been used in epilepsy with good results, but, 
except in certain instances, they fail to act as well as that of potas- 
sium, unless given in larger doses. There are several circumstances, 
however, under which each one possesses marked advantages, and 
may suceed where potassium has failed. In all cases of epilepsy 
complicated with anaemia the bromide of iron should be employed, 
but where there is plethora it will generally increase the disease or 
do no good. When it acts after potassium fails the iron is of value, 
because of its tonic and nutritive effect. Bromide of sodium, while 
somewhat less powerful than potassium, is not by any means so apt to 
disorder the stomach, and is preferable in some cases on this account. 
It possesses no other advantages. 

The bromide of lithium has been highly recommended in intract- 
able cases by Weir Mitchell, who even states that it may be given in 
one-half the dose of the potassium salt with equally good effects. 

The bromide of nickel cures some cases where all other remedies 
fail, but this occurrence is rare. In a series of physiological experi- 
ments made by the writer some years since he found it virtually iden- 
tical with the potassium salt in its action, and it is useful in about the 
same doses and cases as is bromide of potassium. 

The bromide of ammonium is very irritant and disorders the 
stomach quite readily. It ought always to be used, when used at 
all, with some other drugs, the ammonium salt only acting as an 
adjuvant. 



EPILEPSY. 503 

Several clinicians have tried hyclrobromic acid, but it is very much 
more apt to derange digestion and to produce vomiting than any of 
the salts. The dose of the dilute acid is J to 3 drachms (2.0-12.0) 
in a tumblerful of sweetened water. 

The bromate of potassium has been used by Mitchell in doses of 
not more than 5 to 10 grains (0.3-0.65) with good results, but is more 
dangerous and scarcely of greater value. 

There can be no doubt that in some instances what is known as 
the mixed treatment is successful when all else fails. This consists 
mosi commonly of a prescription in which the bromides of potassium, 
sodium, and ammonium take part. Why this combination acts better 
than any one of the salts alone no one knows, but it is certainly a 
clinical fact. 

In still other cases digitalis, when used along with one of the bro- 
mides, seems to produce favorable results. Indeed, digitalis has for 
years been used alone in epilepsy with fairly good results, and should 
always be used in obstinate cases. In petit mal, where bromide of 
potassium when used alone so often fails, it is useful, and several 
English writers, notably Growers, assert that its best effects are in 
cases of nocturnal epilepsy. Why this should be the case no one 
knows, and it would seem doubtful whether it does any more good in 
nocturnal attacks than in others. Indeed, it is difficult to understand 
how digitalis can influence epilepsy at all, for its action on the nervous 
system is slight, save in toxic amounts, when it lessens reflex action 
very markedly — first by stimulation of Setschenow's reflex inhibitory 
centre, and later by paralysis of the spinal cord. This latter action 
never occurs, of course, from a medicinal use ; but in medicinal doses 
it may, by acting on the inhibitory centre, allay convulsive tendencies. 
Probably its chief action is through its circulatory influence, and fur- 
ther study may show it to be efficacious only in those cases where a 
heart tonic is required. 

Another combination very much employed and lauded is bromide 
of potassium with belladonna, the mydriatic being almost useless 
alone, but of great antiquity in its use in epilepsy. Like the mix- 
ture of digitalis and bromide, it succeeds very frequently in petit maL 
and, indeed, seems to be much more successful than the digitalis, but 
its mode of action is exceedingly doubtful. As the drug acts even 
more powerfully upon the nervous system than upon the circulatory 
apparatus, it has been thought that its influence for good depended 
upon this effect, but the experiments of Seppilli contradict this belief, 
for he found that if atropine was given to an animal the surface of 
the cortex cerebri responded more readily than is normal to electrical 
stimulation. 

At one time it was held that belladonna acted on the spinal cord 
and peripheral nerves under such circumstances, but it should be 
remembered that we now know that atropine is only of value in relax- 
ing spasm w T hen given in full dose, oftentimes hypodermically, and 
that Albertoni has made a series of experiments to determine whether 
it irritates the motor centres of the cortex.' In his hands repeated 
small doses or one large dose in no way retarded the convulsions com- 



504 DISEASES. 

monly produced by stimulation of the brain. Both these investigators 
are therefore in accord. Under these circumstances it affects rather 
the motor nerve-endings than the central nervous apparatus. 

At the present time those who believe epilepsy to be dependent on 
cerebral vasomotor spasm rest the occasional good results obtained by 
the use of belladonna on its vasomotor influence; but there is a good 
reason for throwing this idea aside, even if the morbid process named 
was really present — namely, that the drug in ordinary medicinal doses 
raises arterial tension by stimulation of the vasomotor centre, while 
it lowers blood-pressure only when given in toxic amounts, and then 
by an action on the blood-vessel walls. 

As long ago as the early part of this century cannabis indica came 
into notice in the treatment of epilepsy, and it is probably of greater 
value alone than when combined with any other drug, unless it be 
with the bromides, Although it is at present rarely so used, the 
author believes, from his own studies, that it is of value, for he found 
that it distinctly lessens reflex action and acts powerfully upon the 
higher nervous centres in the brain. Its use and value in migraine 
are undeniably of the greatest importance, and epilepsy and migraine 
are often very closely allied. 

G-elsemium sempervirens is an American plant whose praises have 
been widely heard in almost every disease. Its influence alone is 
worthless, for it possesses no power over the cerebral centres what- 
ever, but in combination with cannabis indica it makes a very useful 
remedy, and depresses the conducting power of the spinal cord, while 
the cannabis indica in its turn quiets the cerebrum. The dose of the 
tincture is 20 drops (1.3), but it should be remembered that it is as 
poisonous as the cannabis indica is innocuous. 

Owing to the soporific influences exercised by opium it has been 
very frequently tried, with both success and failure as a result. It 
certainly has not taken any rank in the list of remedies, and is de- 
servedly lacking in professional favor. It increases reflex activity 
very commonly, and seems to affect the intellectual centres of the cere- 
brum rather than the motor portions, although Seppilli's experiments 
show it to exercise a decided depressant influence over these areas. 
Combined with gelsemium it may be employed, but only when 
nothing else is at hand or all other remedies have failed. If it is so 
employed, great care is to be used, and it should not be forgotten that 
both drugs kill by respiratory failure, When used in the " status epi- 
lepticus "it often does good in relieving the spasm, but it must be 
employed in large doses, and if the succeeding coma of epilepsy has 
added to it that of large doses of opium, death may ensue. 

The employment of zinc, in its various salts, has been greatly 
recommended for many vears, but has found little favor of late among 
the profession, It has been stated that it quiets the cerebral cortex, 
the medulla oblongata, and the spinal cord, and in this way cures the 
attacks. This is, however, merelv clinical evidence, and has no ex- 
perimental proof to support it. Even its most sanguine supporters 
confess that the range of usefulness of zinc is generally in those cases 
where the bromides succeed, and agree that its powers are much infe- 



EPILEPSY. 505 

rior to these compounds. The dose of the oxide is 3 to 7 grains 
(0.15-0.5) twice or thrice a day, and even in this amount it may cause 
nausea and vomiting. The citrate of zinc is more soluble, and is bet- 
ter borne by the digestive apparatus. Its influence over the disease 
is probably the same as that of the oxide, and this is also true of the 
lactate, which was so largely used by Herpin, and which is probably 
the best salt of zinc to employ. 

Nitrate of silver was brought into use long before the value of 
more recent drugs was known. Every one is agreed that it is with- 
out power for good, save when it is used constantly for a long time. 
As the drug is eliminated very slowly, it rapidly accumulates in the 
body, and argyria soon comes on. It may be used, after all else fails, 
in doses of -J- to J grain (0.01-0.15) thrice a day after meals, the 
mucous membrane of the inside of the lips and the conjunctiva being 
carefully watched for the early signs of chronic silver poisoning. We 
certainly have no knowledge as to its influence on the nervous sys- 
tem ; and if it acts at all, it must be by some alterative influences 
rather than by any other means. 

Nitroglycerin is to be employed in the treatment of petit mal, 
rather than haut mal, in the dose of 1 drop (0.05) of a 1 per cent, 
solution, once, twice, or three times a day. Our knowledge of its 
effects, so far as its curative influences are concerned, is very slight, 
but it seems to benefit some cases. Its action is very fleeting, and it 
influences the brain very little, except it be taken just before an 
attack is expected or when the cardiac action is defective. Its great 
lethal power should never be forgotton. 

The use of the nitrite of amyl is not for the purpose of directly 
curing the disease, but of warding off" impending attacks, the warn- 
ing of which is given by an aura of slow progression. It increases 
the severity of petit mal, but in epileptics who have a prolonged aura 
we may use nitrite-of-amyl pearls, which consist in small glass beads 
containing a few drops of the drug. As the aura comes on the 
patient should break one of these in his handkerchief and inhale 
the drug, thereby putting aside the attack. The influence which the 
drug exerts upon the brain is secondary rather than primary, and is 
probably dependent on its action on the blood or circulation. Its 
influence on the spinal cord and nerves is much more marked and 
direct, and it is most certainly a very powerful spinal depressant. As 
its influence over unstriated muscular fibre is very great, it affects the 
vasomotor system very powerfully ; and those who think epilepsy is 
due to a vasomotor spasm at the base of the brain point to the effects 
of this drug as a proof of their hypothesis. Such reasoning is not, 
however, necessarily correct. Nitrite of amyl puts aside an attack by 
a sudden shock to the nerve-centres, which diverts them, so to speak, 
from their intended discharge, very much as a ligature around the 
arm stops an aura. When we remember that the drug acts instantly 
and converts nearly all the oxygenating blood of the body into a non- 
oxygen-carrying fluid by reason of the methsemoglobin produced, 
the sudden change in the cerebral nutrition and state is easily 
understood. 



506 DISEASES. 

In the treatment of the " status epilepticus " nitrite of amyl is of 
great value in stopping the seizures, and may be used under these 
circumstances in heroic amounts, applied to the nostrils at intervals. 
During the presence of the tonic spasm, if it be severe enough to stop 
respiration, it should be remembered that if the drug is not inhaled 
it is absolutely worthless. It is only when respiration is being carried 
on that it can enter the lungs and do its work. Another valued 
method in treating the status epilepticus is free bloodletting. The 
nitrite of ammonium or of sodium should be used internally to sup- 
plement the nitrite of amyl. 

Gowers states that nitrite of amyl does good in epilepsy by flood- 
ing the brain with arterial blood. How such a statement can be made 
by any one is amazing. Of all the drugs in the world, nitrite of amyl 
produces exactly the opposite change. 

The use of anaesthetics during an attack of epilepsy is virtually 
useless, and in some cases dangerous, for ether is too slow in its effects, 
and may, by its irritant vapors, increase the tendency to laryngeal 
spasm or cause lung complications. Further than this, if uraemia is 
the cause of the fit — and this fact is unknown in every case until the 
individual is carefully examined — the ether may increase the inflam- 
mation of the kidneys very seriously. 

Chloroform, though it acts much more rapidly, may cause sudden 
cardiac failure, and both drugs may increase the post-convulsive coma 
very greatly. In "status epilepticus " they may be used, as in such 
cases the convulsions must be stopped at all hazards, but the prefer- 
ence should be always for amyl nitrite. 

The iodide of potassium is entirely useless in epilepsy unless the 
disease is due to syphilis, when it is of the greatest service. Indeed, 
the bromide and all other drugs should be set aside while this one is 
pushed to the utmost. As is well known, syphilitics usually bear the 
drug extremely well, and the author knows of one instance where no 
less than 800 grains (53.0) were taken every tAventy-four hours, with 
rapid improvement as a result. This point is strongly insisted upon 
by all therapeutists and syphilographers, notably among whom stands 
Fournier. 

Where the convulsions are due to the presence of a gumma, the 
iodide of potassium is, however, too slow in its action, and should be 
associated with mercury in order to break down the growth without 
delay, lest a seizure cause death by glottic closure, producing asphyxia 
or some similar accident. 

Some difference of opinion exists as to the usefulness of iron in 
epilepsy. Several very eminent clinicians have asserted that it always 
makes the attack worse, and therefore does more harm than good. 
Like everything else, iron is no more to be given in every case than 
is a dose of oil ; when there is plethora it is harmful, and when there 
are malnutrition and anaemia it does good. Over the disease itself 
iron has really no effect at all, except through its action on the gen- 
eral system. 

Chloral hydrate is a remedy which has been only partly tried in 
epilepsy, and its usefulness is not as yet determined. It possesses the 



EPILEPSY. 507 

marked disadvantage, as compared with the bromides, of being a 
very fatal poison, which is an important fact to be borne in mind by 
the physician when giving it to a patient whose mind is already weak- 
ened by the disease or naturally stupid, and who may forget and take 
too much. Its physiological action indicates much more fully that it 
may be of value than does that of many other much more lauded rem- 
edies, since it exerts its chief influence on the motor pathways of the 
spinal cord and quiets the motor portion of the cerebral cortex, and 
also produces sleep. Seppilli has proved this by direct experimenta- 
tion after the method employed by Albertoni. Its use, combined with 
one of the bromides, is often accompanied by the most desirable results, 
and it should be tried at all times unless some cardiac complication 
forbids it. It may disorder the stomach, and should, like the bromides, 
always be given well diluted and after meals. 

Of the more recent remedies, acetanilid certainly stands in the 
foremost rank, and bids fair in some instances to rival the bromides. 
Professor Germain-See, the author, and some others have reported 
cases which obtained very marked relief from it, and more recent 
investigators have done likewise. The drug will be found to exert 
its chief benefits in chronic epilepsy. At least, if a child was brought 
to the author with a beginning epilepsy he would use the bromides, 
but, if the disease was chronic, acetanilid. 

Antipyrine has also been pushed forward as a remedy, and its 
physiological action on the nervous system is virtually identical with 
acetanilid. 

Antipyrine has been recommended by Lemoine in certain forms 
of epilepsy, but condemned in most cases. In those who suffer from 
menstrual epilepsy, so called, or in those in whom the attack is pro- 
duced reflexly by the presence of intestinal parasites, the drug does 
good. 

Lemoine also found it very useful in those cases which are asso- 
ciated with migraine. In these cases the results were better than 
with the bromides, but in the idiopathic simple varieties it was use- 
less. Mairet and Combemale have used the drug in the epileptiform 
mania with satisfactory results. 

In the epilepsy of childhood Solanum carolinense in the form of 
the fluid extract, in the dose of 2 to 15 minims (0.1-1 cc), is a useful 
drug. 

In children suffering from frequently recurring epileptic attacks 
the presence of worms should always be looked for, and when they 
are found they should be expelled as rapidly as possible. If they are 
the oxyuris vermicularis (seat-worms), the best remedy by far is the 
injection of a strong infusion of quassia of such a strength that there 
are 2 ounces (64.0) of quassia to each pint (500 cc.) of water. 

In girls, where the removal of the worms from the rectum is not 
followed by relief, a careful examination of the vagina should be 
made, and quassia employed in somewhat weaker solution, as very 
commonly intense inflammation is there present, produced by migra- 
tory movements of rectal parasites. If the quassia is unobtainable in 
any case, a saturated solution of chloride of sodium may be employed. 



508 DISEASES. 

The treatment of epilepsy by borax has not received very wide 
recognition. Perhaps the most thorough studies of its effects have 
been those of Gowers in England and Folsom in America. It would 
seem that some cases which are obstinate under ordinary treatment 
are benefited by borax, but it is certainly not to be commonly 
employed. The dose generally given is about 15 grains (1.0). (See 
Borax.) 

Having spoken of the drugs which may be given to epileptics, 
attention may be drawn to those which may not be used. There is a 
very large amount of reliable evidence, both experimental and clinical, 
that quinine should never been employed in these cases when it can 
be avoided. Thus Seppilli in his researches found that it increased 
the irritability of the cerebral cortex, and Briquet has asserted that 
it is a direct cerebral stimulant. That toxic doses of quinine may 
provoke epileptiform convulsions has been proved by Jakowbowich, 
who has seen them occur in cinchonized dogs and other animals, and 
Brown-Sequard and Albertoni have noted that cinchonidine and 
quinine always increase the number of attacks in epileptics. 

Salicylic acid, too, has an effect upon the brain very closely allied 
to that of quinine, and should always be used with care in cases of 
epilepsy. Professor Germain-See has also pointed out that large 
doses of this drug produce violent epileptiform convulsions in the 
lower animals. 

Strychnine, while its chief effect is to heighten the activity of the 
spinal cord, also, according to Seppilli, increases the irritability of 
the cortex, and should be employed only in peculiar cases. The same 
writer also found that absinthe and picrotoxin predispose to epileptic 
seizure by increasing the excitability of the motor zone of the cerebral 
cortex. 

Bleeding the patient in ordinary attacks of epilepsy, unless there 
is marked evidence of cerebral congestion, which is exceedingly rare, 
is harmful rather than of value, but in cases of status epilepticus is of 
value. Orschansky found that removal of one-seventh of all the 
blood in the body by the femoral vein did not lessen the irritability 
of the cortex, and Minskowsky ligatured all the blood-vessels going to 
the brain without decreasing its excitability. 

A very important point, which is constantly brought before the 
physician who is treating epilepsy, is that of diet. Nearly every 
patient who suffers from this disease inquires what he shall eat. Very 
few researches of a thorough character have ever been carried out on 
a large scale to determine the things which may or may not be in- 
gested. Of course, nearly every one of us knows from our personal 
experience that red meats are hurtful, particularly in children. Curi- 
ously enough, the influence of diet in one research covering a number 
of cases of chronic epilepsy seemed to be of little moment. Thus, 
Merson examined 24 such cases, putting 12 of them on a purely vege- 
table, and 12 on a purely nitrogenous, diet. The result, after this 
study had been continued for two months, was that the vegetarians 
had had a few less fits than the others, but the difference was so slight 
as to be of almost no weight in determining the question. Some 



EPISTAXIS. 509 

authors at the present day believe this opinion as to the harmfulness 
of meats to be erroneous, and Growers is one of them. 



EPISTAXIS. 

Nose-bleed depends upon many causes, the chief of which are 
traumatisms, plethora, and the presence of ulcerations in the nasal 
chambers. It also occurs as one of the prodromata of typhoid fever. 

Probably plethora is the most frequent cause of nose-bleed, and in 
most instances it is an attempt on the part of the system to rid 
itself of an excess of blood. Under these circumstances epistaxis 
is not dangerous, nor is it proper to arrest it unless it becomes exces- 
sive. Where it is excessive or must be controlled for any reason, the 
measures to be adopted are both medicinal and non-medicinal. If 
the person is full-blooded and strong, full doses of tincture of aconite 
or veratrum viride are useful, say 2 to 4 drops (0.1-0.2) of one of 
them, followed in a half-hour by a smaller dose, if necessary. The 
value of these drugs depends upon their power of lowering blood- 
pressure, and in consequence decreasing the leakage from the break 
in the wall of the blood-vessel. Some physicians have recommended 
ipecac in full nauseating doses to relax the arterial system. Powdered 
alum, pure or half and half with starch, or alum in solution, may be 
snuffed up the nostril, and tannic acid, in powder or in solution, may 
be used with advantage. If this does not control the hemorrhage, an 
atomized spray of Monsel's solution, in the strength of 30 drops to 4 
ounces (2.0 : 128.0) of water, may be of service. Ergot in the form 
of the fluid extract in the dose of 1 drachm (4.0) may be given, or its 
wine in the dose of a wineglassful (32.0) employed. Sometimes, when 
the oozing is slow, doses of turpentine taken internally, oil of erige- 
ron, or hamamelis, do good. As a household remedy vinegar may 
be injected into the nostrils, or lemon-juice may be employed in the 
same way. 

All these remedies act as styptics when locally applied, by causing 
coagulation of the fibrin and the formation of a clot, while the inter- 
nal remedies produce local contraction of the blood-vessels in the con- 
gested area, this area being more susceptible to the influence of these 
drugs than the rest of the vascular system. 

The non-medicinal measures to be employed if the bleeding is 
severe consist in plugging the anterior nares with pledgets of cotton 
or pieces of lint soaked in vinegar. If this does not control the 
hemorrhage, the posterior nares may also be closed by plugs, and 
compression of the facial artery of the same side as the bleeding nos- 
tril be made upon the superior maxilla near the nose, thus decreasing 
the blood-supply. The head must be kept raised, and the patient 
must not bend over a basin or wear a tight collar. 

A piece of bacon fat cut to fit and placed in the nostril may stop 
epistaxis which has resisted all other measures. 

Sometimes, if the patient raises one or both hands high above the 
head, the hemorrhage ceases. This is due to the fact that the easiest 



510 DISEASES. 

pathway for most of the blood is straight up the brachial arteries 
rather than through the tortuous vessels of the face. A hot foot- 
bath, by dilating the veins of the lower extremities, draws away the 
blood from the face and is a useful measure. In other cases a hot- 
water bag applied over the dorsal vertebrae is efficacious, and some- 
times cold when so used is of service. A piece of ice pressed against 
the nose may prevent further hemorrhage by causing localized 
anaemia. 

Where the nasal hemorrhage results from traumatism with fracture 
of the bones, and great loss of blood ensues, ligation of the bleeding 
vessel or its supplying vessel should be, if possible, resorted to. 



ERYSIPELAS. 

This disease is now generally recognized as dependent for its 
existence upon a germ. The streptococcus of erysipelas is practi- 
cally identical with that of pus, and the disease is at first a distinctly 
local one. The changes which have come forward in its treatment 
are chiefly the local measures, while those methods which have been 
used internally for many years have suffered no alteration. 

Whether or not erysipelas is a local or systemic disease has little 
to do with the proper treatment. In any case it is an inflammation, 
and as such it must be treated. In its early manifestations and where 
some uncertainty may exist as to its true character aconite or vera- 
trum viride may be used in sthenic cases in which the nervous and 
circulatory systems give evidence of reflex irritation and the pulse is 
hard and full. These remedies are contraindicated if any tendency 
to weakness exists. DaCosta has recommended, and others have car- 
ried out with success, the practice of using pilocarpine in sweating 
dose (J to -g- grain hypodermically) in these early stages. (See Pilo- 
carpus.) As with aconite and veratrum viride, it is to be remembered 
that this use of pilocarpine is not to be resorted to if debility exists. 
When the disease is too far advanced to be aborted, belladonna in the 
dose of 3 to 5 minims (0.2-0.35) of the tincture every four hours 
should be used. It may also be locally applied on lint with benefit, 
or belladonna ointment may be smeared on the skin. 

The internal treatment of erysipelas par excellence is the plentiful 
use of the tincture of the chloride of iron — 20 to 30 drops (1.3-2.0), 
or even 40 drops (2.65), four times a day. The diet should be reg- 
ulated and the bowels kept in good order, while any excessive febrile 
movements are to be treated by the use of antipyretic drugs, such as 
antipyrine — better still by cold bathing. Where the patient passes 
into the typhoid state supportive measures must be used and alcoholic 
stimulants added to the food, which should be predigested or prepared 
so as to be readily absorbed. 

During convalescence the use of tonics, both in the form of iron 
and of bitters, is particularly indicated if the recovery of strength is 
slow. The local treatment of erysipelas is very varied, but in the 
majority of cases resort need be had to but one or two methods. 



FEET. 511 

By far the best dressing for the general run of cases of erysipelas 
is a modification of that of Von Nussbaum, which the author has tried 
in a number of cases with great success. The skin of the part 
involved is carefully cleansed with castile soap of the purest form, 
which is washed off by a 1 : 1000 solution of bichloride of mercury. 
The skin is dried with a soft towel, and a thick coating of ichthyol 
and vaseline or lanolin applied, the strength of this ointment being 
half and half. Over this is placed antiseptic gauze or sterilized 
absorbent cotton, and adhesive strips or a bandage is used to keep 
the dressing in place. Sometimes the ointment alone may be applied 
if the area is small. Under this treatment the results are often extra- 
ordinary in all stages of the malady. Where ichthyol is not obtain- 
able, a thick coat of white-lead paint, as it is sold in cans before it is 
mixed with any thinning substance, will be found of service in an 
emergency. 

The plan recommended by Higginbottom, of applying nitrate of 
silver, is sometimes successful. It consists in the use of a solution 
of the strength of 80 grains to 4 drachms (5.3 : 16.0) of distilled 
water, which is thoroughly applied with a camel's-hair brush over the 
entire inflamed area and for a little space beyond. The application 
must be made twice or thrice to secure a good coating. This treat- 
ment will often arrest the inflammation and prevent its spread, but 
has caused sloughing. 



EXHAUSTION AND DEPRESSION. 

While the treatment of both these conditions is almost identical in 
some respects, it is, nevertheless, important that a clear idea of the 
difference between the two be clearly understood, if for no other 
reason than that the physician may recognize that exhaustion is a 
far more serious state than depression. It also requires more careful 
treatment. The man who is depressed retains in his body all the 
vital forces necessary for the maintenance of life, but they are tem- 
porarily in abeyance from some cause. As soon as the incubus is 
taken away the system at once asserts itself and recovery takes place. 
This is not the case with a man suffering from exhaustion. In this 
patient every particle of his strength is sapped and lost. The man 
depressed is the giant lying unconscious from a blow on the head ; 
the man exhausted is the same giant after a long attack of typhoid or 
other fever of a similar nature. The treatment of depression is stim- 
ulation ; of exhaustion, not only stimulation, but feeding and protec- 
tion from exposure. 



FEET SWOLLEN, TENDER, OR SWEATING. 

These comparatively simple yet annoying conditions are often 
brought before the physician for relief, and patients suffering from 
them will frequently be more grateful for skilful treatment than in 
the event of recovery from a severe illness. 



512 DISEASES. 

Swelling of the feet occurs chiefly in two classes of cases, except- 
ing, of course, in dropsy, which makes a third class. These are old 
persons taking too little or too much exercise, and who may have 
gouty or rheumatic tendencies, and those who by constant standing 
or walking cause congestion of the lower extremities, chiefly by fatigue, 
or by wearing bad shoes, or by running over uneven ground, causing 
bruising. Where the swelling takes place in the first class, small 
doses of arsenic, in the dose of -g 1 ^- to -fa grain (0.001-0.0015), often 
do good, and careful examination should be made of the circulatory, 
renal, and respiratory apparatus to discover any weak points, such as 
vascular relaxation or tendencies to varicosities. The distilled or 
fluid extract of hamamelis is often of service in the dose of J to 1 
drachm (2.0-4.0) of the former and 10 to 20 drops (0.65-1.3) of the 
latter preparation. In some cases absolute rest of the feet will be 
necessary before cure is reached. 

Where the feet are tender the most common cause is bruising from 
too thin soles on the shoes, too tight shoes, and from abrasions or skin 
disease. More commonly than all they become sore from excessive 
sweating and resulting maceration. 

The treatment of sweating and tender feet is, of course, the removal 
of the cause and the use of remedies designed to toughen and harden 
the skin of the parts. Probably the best application for this purpose 
is a solution of salicylic acid and borax, half and half, in water and 
glycerin, rubbed over the feet night and morning. If the sweating 
is very severe, the stockings worn should be clean each day, and pre- 
viously soaked in a strong solution of borax and dried. The follow- 
ing prescription affords a useful powder : 

R. — Pulv. acidi salicylici gr. xx vel xl (1.3-2.65). 

Pnlv. acidi borici ^ij (8.0). 

Pulv. amyli q. s. ad sj (32.0).— M. 

S. — To be dusted over the feet night and morning, after washing and thoroughly dry- 
ing them. 

Sometimes the use of cotton instead of woollen stockings may 
aid in the cure. 



FEVER, AND ITS TREATMENT. 

(For the Treatment of each Fever, see its Title.) 

At the present time the medical profession are almost universally 
of the opinion that fever is a disorder of calorification dependent 
upon nervous action, said nervous action being the result of various 
causes, such as the presence of poisonous materials in the blood or 
of perverted functional activity of heat-centres. The first may be rep- 
resented by the fever of any infectious disease ; the second-, by the so- 
called hysterical hyperpyrexia. Turning from the general question of 
fever to those drugs which combat it, we are met at once by an array 
of synthetically prepared substances which are almost without number, 
and which are derived chiefly from the tar found always in close prox- 
imity to deposits of coal. 



FEVER, AND ITS TREATMENT. 513 

The value of a drug which can decrease high temperature by influ- 
encing heat-production alone cannot be over-estimated, and while sev- 
eral drugs seem to influence this part of the heat apparatus more than 
that portion connected with the dissipation of heat, we have no sub- 
stance which is distinctly and solely capable of exercising an inhib- 
itory power over the development of heat in the body. Frequently 
one of the substances put forward by its discoverer as a useful anti- 
pyretic remedy has been found so to depress the heart or respiration 
that it cannot be used, while others produce secondary lesions in the 
tissue of the body by more slowly acting influences. For both experi- 
mental and practical purposes Ave may therefore divide antipyretics 
into three great classes : First, the substances which allay or prevent 
fever by inhibiting its production ; second, the drugs which possess 
the power of decreasing bodily temperature by increasing the dissi- 
pation and decreasing the production of heat ; and third, the com- 
pounds which allay fever, not by stopping the manufacture of heat- 
units, but by so increasing the exhalation of heat that the loss is 
greater than the manufacture. The first and last of these three 
classes are directly opposed to one another. The second class is half- 
way between, and it is to this class that most of our antipyretic drugs 
belong. The first is the ideal ; the second is the one we have to be 
content with ; the third is the one used by our forefathers, and is the 
most dangerous and unreliable, since the tissues are quite as rapidly 
destroyed as before the drug was given, the centre of the body 
remaining in pyrexia, while the cool skin and extremities are apt to 
lead the physician into the belief that the fever no longer exists. 
The tissue-waste of the fever goes on unchanged, and the patient, if 
the disease be prolonged or asthenic in character, is in almost as bad 
a condition as when no such antipyretic attempt has been made — 
almost as badly off, because it should never be forgotten that hyper- 
pyrexia, or even ordinary fever, is dangerous in two ways — namely, 
by destroying tissue and reducing vital power, and by acting simply 
as too great bodily heat, and thereby producing nervous or cardiac 
symptoms, such as are seen in cases of sunstroke and heat-exhaustion, 
where the condition of the patient is the result of coagulation of the 
cerebral or cardiac protoplasm, or is one of depression of all vital 
function. 

Closely allied to this question is that which asks us to define what 
we mean by hyperpyrexia. As given by most workers upon the sub- 
ject of fever, this term is applied to any state in which the temperature 
reaches 106° or 107° F., but in reality this has nothing to do, except 
in an indirect way, with what the student or physician wishes to know. 
This is but another example of the fact that the presence of a high 
temperature alone does not constitute the sole indication for the 
treatment of the disease, the physician being governed by the state 
of the patient who is laboring under the malady. A temperature of 
106° F. in a young healthy man suffering from an attack of some 
short-lived disease does not mean very great danger, but a tempera- 
ture of 103° day in and day out in typhoid fever does mean dan- 
ger, and must be carefully attended to. The question is one not of 

33 



514 DISEASES. 

actual degree Fahrenheit, but rather as to whether the temperature 
present is doing any harm. 

Turning to the drugs which are divided into classes named from 
their physiological effects, we may, in view of our present knowledge, 
place them as follows : First, those which decrease heat-production 
alone are not known. Second, those which act both on dissipation 
and production are antipyrine, acetanilid, carbolic acid, salicylic acid, 
similar substances, and quinine. In this class, also, should be placed 
cold bathing, which probably decreases heat-production as well as 
increases heat-dissipation. Third, those drugs which only dissipate 
heat, as far as we know — namely, the great group of cardiac sedatives 
and their allies. 

No one is more sensible of the fact than the writer that this 
arrangement of the subject is partly artificial, but in the present state 
of our knowledge it is probably the best we can do. 

Though a number of writers have claimed that certain antipyretic 
remedies of equal power act with different results in different diseases, 
the writer has never been able to see any such distinction, and we 
must be guided rather by experience as to the value of some particular 
antipyretic in all diseases than by any other rule. All observers are 
not in accord, however, as to the best one of this class. While phe- 
nacetin has been spoken of very highly by some authorities, the 
writer has heard it equally condemned by others, and, although 
Ringer prefers antipyrine, Mitchell Bruce relies chiefly on acetanilid. 
In America many persons prefer the antipyrine, but there are many 
others who rely solely on acetanilid, the general diffusion of this 
preference apparently resting upon personal experience. 

It may be said that we have only three measures for the relief of 
fever which are reliable and have stood the test of time. These are 
the employment of antipyrine and acetanilid, and the use of cold. 
(For the mode of using antipyrine and acetanilid see pp. 43 and 72, 
and for the use of cold see p. 367.) 

For many years the profession of medicine has been in the habit 
of feeling the pulse with the perfectly proper object of determining 
what the state of the system is as it appears on this sign-board of the 
body, but it has only been of late, when our knowledge has increased, 
that we have come to consider the pulse-rate and force as something 
more than a simple aid to diagnosis. At present many seem to for- 
get that the very value of the pulse as a sign-board depends upon its 
readiness to obey the beck and call of the variations in the body, and 
to consider that in fever, for example, the pulse is rapid, not because 
the fever makes a rapid pulse, but that a rapid pulse and fever are 
equally dangerous conditions, both of them of primary importance ; 
in other words, these persons regard the rapid pulse, not as the result 
of a high temperature, but as a symptom in itself. 

While in our present state of knowledge concerning the poisons 
which produce fever Ave cannot assert that none of them act on the 
heart in the same manner as do certain drugs, thus altering the pulse- 
rate and force, we are able by experiments to prove that high tem- 
perature of itself does seriously alter the heart-beat, and, in addition, 



FEVER, AND ITS TREATMENT. 515 

that antipyretics, as a general rule, in lowering the fever lower the 
pulse, not directly, but indirectly. Such results are to be gleaned 
from the studies of Lauder Brunton, Newell Martin, and several 
other workers in this field, who have found that febrile temperatures 
stimulate the accelerator cardiac nerves. 

Closely associated with this question is that of the relationship 
between arterial pressure and fever. It at once becomes evident that 
if heat stimulates the accelerator nerves, an increased rapidity of car- 
diac action must ensue, and, in consequence, an increase in the 
amount of blood thrown into the arteries must result. As a conse- 
quence of this the arterial pressure must rise, even if the vasomotor 
system gives response in no way to the heat. In nearly all cases of 
high fever, however, unless the system be greatly exhausted, the vaso- 
motor apparatus certainly is excited to increased activity. 

As the writer has spoken of the dangers of high fever, it is not 
right that the impression be given that every one believes with Lie- 
bermeister in the absolute harmfulness of such states. While the 
profession in general accept such views, the opponents to them, though 
not great in number, have been so prominent as individuals that their 
studies cannot be passed by. In 1883, Unverreicht tried to rebut the 
testimony then so rapidly accumulating in favor of antipyretic meas- 
ures, and still later Naunyn, in a very carefully written and logical 
paper, positively denied their value and usefulness. While he grants 
that high temperatures are most important in prognosis and diagnosis, 
and that certain antipyretic measures do good, he nevertheless insists 
that, though the cold bath does good primarily, its effect upon the 
nervous system nullifies its direct action upon the fever. He acknow- 
ledges, of course, that such temperatures as 108° or 110° F. are of 
dangerous import in themselves. To prove that his assertions are 
correct, Naunyn gives results reached in a series of studies made by 
him on animals. He found that healthy rabbits will bear a tempera- 
ture, artificially induced, of 106° to 107° F., rising at times to 108° 
to 109° F. for days together, without any injury. He further states 
that in many autopsies he has failed to find any lesion present as the 
result of exposure, except a slight cloudiness of the renal epithelium. 
The author cannot help calling attention to two facts which Naunyn 
apparently overlooked in common with many of the readers of his 
paper — namely, that 106° to 107° F. is only a few degrees above the 
rabbit's normal heat, which is about 103° F., so that the pyrexial 
temperature of these animals corresponded to but 101° or 102° in 
man — a temperature easily borne in many fevers. Second, it should 
be remembered that this heat was applied constantly in these studies 
to the animal, which did not have to manufacture the heat itself. 
Although, at first, this seems unimportant, it should not be overlooked, 
as the tissue-changes in the two instances are entirely different : to 
use a homely simile, in one case the stove is kept warm by heat 
applied to it externally without the combustion of its tissues, the 
coal ; in the other case the stove is kept hot by the use of the coal 
itself. Very different changes are naturally found in the two cases 
in the coal. The author cannot go further into these questions ; suf- 



516 DISEASES. 

fice it to state that, while high temperatures are borne in some 
instances Avith no evil results, the majority of cases do not turn out 
so favorably. 

The various opinions expressed by well-known German clinicians 
concerning this question have been collected by Ziemssen. Speaking 
of the Y/orth of antipyresis in any form, he divides the writers of the 
last twenty years into groups, as follows : First, the extreme hydriat- 
ricists, who only use cold bathing and object to internal antipyretics, 
such as Vogel, Winternitz, and others. Second, the moderate hy- 
driatricists, who resort to lukewarm baths, but reject internal anti- 
pyretics, among whom may be named Naunyn and others. Third, 
those who, according to indication, resort to moderate hydropathy and 
to antipyretics, such as Jiirgensen and Reiss. Fourth, those who 
consider fever as a salutary and necessary regulator, and only resort 
to antipyretics when dangerous symptoms arise, as Huebner, Cursch- 
mann, and others, Fifth, those who claim that fever is a necessary 
phenomenon, and therefore reject all attention to antipyresis and 
attend to diet (Glaser). Finally, those who absolutely deny the 
influence of treatment on the mortality of fever (Port). 

Truly, it would be hard to find a set of more diverse and contra- 
dictory opinions on so limited a basis, but the practice of Jiirgensen 
and Reiss has virtually proved the value of antipyretic measures, and 
they are resorted to by most of us. Those who have tried them rely 
on this method very largely, and they are certainly an advance in 
therapeutics. 

A very important question arises as to the value of cold bathing 
in private practice. There can be no doubt of its acting well under 
these circumstances if carefully carried out, and it is certainly much 
the best remedy for fever where trained nurses are on hand to admin- 
ister it, but where only members of the family are in care of the sick 
man, and where the doctor can only be on hand once in twenty-four 
hours, it is manifestly impossible to resort to it. Even if the bath be 
properly given, the exhaustion produced by clumsy handling may 
more than counterbalance all the good achieved. It has been claimed 
that the cold pack never results in cardiac failure, as does the use of 
antipyretics. We are quite confident of the fallacy of this statement. 
Indeed, the writer has recently seen such a case. The cold pack can- 
not be used more carelessly than antipyretic drugs, and it is probable 
that when this measure is more widely employed more reports will 
appear in the medical magazines of accidents occurring as the result 
of its abuse. (See Cold in Fevers, Part III.) 

Sthenic Fevers. 

The application of antipyretics to the febrile temperatures occur- 
ring in sthenic cases has an entirely different purpose from their 
employment in a prolonged low fever of the adynamic type. There 
can be little doubt that in the sudden excessive outbursts of febrile 
temperature in a child from functional disorder, but with no acute 
disease underlying it, antipyretics are of great value, and there are 



FEVER, AND ITS TREATMENT. 517 

also reasons for their employment in the treatment of children and 
adults in order to favor popular prejudice. In America, at least, a 
physician visiting a case of croupous pneumonia for the first time, and 
finding the patient with a high fever, would not be allowed to give 
the patient a cold bath if the friends could prevent it, and he must, in 
consequence, fall back upon antipyretics. Again, the fever of such 
cases cannot be prolonged enough to necessitate the use of antipyrine 
day in and day out for weeks at a time, and there is, for this reason, 
less danger of the patient being injured by its influence. In scarlet 
fever the use of such drugs should be most carefully watched, because 
the kidneys are in danger and the disturbances accompanying the fever 
may last a long time. 

In pneumonia and erysipelas in strong persons antipyretics find 
their true place. Lasting about a week in their febrile activity, these 
diseases are often accompanied by sudden hyperpyrexia, which must be 
overcome at once by a drug, and the temperature is so apt to rise at 
any time to a dangerous degree that some remedy often has to be left 
in the hands of the nurse with instructions to use it if a hyperpyrexia 
should assert itself. Even in these cases cold is the best remedy, but 
the physician must be careful to see that it is properly applied, or it 
will be harmful instead of useful. 

In thermic fever, or sunstroke, the employment of antipyretics is 
often useless. The excessively rapid upward rush of the temperature 
responds in no way to drugs, and there are cases on record in which 
the use of antipyrine has utterly failed of good result. Thus, in one 
case reported by Singer a man suffering from thermic fever, with a 
temperature of 108 degrees, received 50 grains (3.3) of antipyrine 
hypodermically at 6 p. M. ; at 7 P. M. he received 10 grains (0.65) 
more under the skin; at 8 P. M. 20 grains (1.3) more; and at 9.30 
another 20 grains (1.3) were used without effect. In other words, 
100 grains (6.6) in three hours and a half proved useless. In chil- 
dren suffering from excessive heat during summer weather antipyrine 
seems to be very useful, and has been highly recommended by Demme. 
It must be used with caution lest collapse be induced, and the author 
would much prefer the use of cool sponging. 

Asthenic Fevers. 

(Typhoid Fever and Fevers of a Typhoid Type.) 

In the opinion of the author, antipyretics should play a secondary 
role in the reduction of the pyrexia of the typhoid state, our main 
reliance being upon cold applications, the antipyretics being used 
as an adjunct to the cold pack or bath. Aside from the fact that 
he has found such an opinion well founded in a large number of 
typhoid-fever cases, logical reasoning endorses its correctness. Even 
if antipyretics were perfectly innocuous, their constant use in fever 
would but give the already overstrained kidneys the task of their 
excretion, while the stomach, sufficiently disturbed by necessary med- 
icines and illness, has enough to do without the addition of an addi- 
tional load. Further than this, we know that these drugs are not 



518 DISEASES. 

perfectly harmless, and we also know that they act on the protoplasm 
of the body, and in consequence must gradually lose their power, 
which is not the case with the cold pack. The writer is sure that in 
typhoid and other low fevers of the continued type antipyretics should 
be given only when the cold pack cannot be used, or at the end of the 
cold application to prevent the temperature from bounding upward 
after its depression. (For Brand's treatment see Typhoid Fever.) 
Further than this, fever will sometimes resist all doses of antipyretics 
we can give or all that it is safe to give, but no fever can resist the 
cold bath. In diseases of a more chronic type, particularly those 
represented by phthisis, antipyretics are of doubtful value, owing to 
the increased sweating which is so apt to be produced, and unless the 
patient seems to be particularly robust they should not be employed 
except in the smallest available doses. 



FRECKLES AND CHLOASMA. 

The removal of freckles is readily accomplished, but their return 
is inevitable if any exposure to the sun or wind occurs. One of the 
best applications for their removal is a solution in water of corrosive 
sublimate varying in strength from 1 to 4 grains to the ounce (0.05— 
0.2 : 32.0), and applied night and morning until the skin shows that 
it is irritated, when the lotion must be stopped for some days, after 
which its use may be begun again. A very efficient and much less 
dangerous remedy to leave about the room in which children are 
allowed to play is a saturated solution of boric acid in water, applied 
in the same manner as is the solution of bichloride of mercury. 

Another remedy is lactic acid, 10 grains to a drachm (0.65 : 4.0) 
of water, used in the same manner as the solution of the bichloride 
of mercury. The following prescription is recommended by Unna : 

R. — Bismuth oxidi) -- , A \ 

Pulv.amyli } aa gr. xxx (2.0). 

Kaolini 3j (4.0). 

Glycerini fgij (8.0). 

Aqupe rosae q. s. ad f^ij (64.0). — M. 

S. — Paint on spots and allow to dry, washing the drug off before each new appli- 
cation. 



Or the following may be used 

R. — Zinci oxidi .... 
Hydrarg. ammoniati 
01. theobromse . . 

01. ricini 

Essent. rosse . . . 
S. — Apply night and morning, 



gr. iij (0.2). 
gr. iss (0.08). 
f^ijss (10.0). 
f^ijss (10.0). 
gtt. x (0.65).— M. 



GASTRALGIA. 1 

The treatment of gastralgia may be divided into two parts — that 
directed to the relief of the attack when it is present, and that de- 

1 See article written by author in Keating 1 s Cydopcedia of Diseases of Children, 
vol. iii. 



GASTRALGIA. 519 

voted to the prevention of other attacks. During the acute stage 
hot applications and drinks, aromatic and locally stimulating -warm 
infusions, a few drops of chloroform, or brandy or whiskey hot and 
concentrated, or 30 or 40 drops (2.0-2.65) of laudanum may be used. 
Counter-irritation often does good, and in some cases, particularly if 
a suspicion of an hysterical element exists, a vigorous revulsive may 
act with surprising success. Emesis and purgation are sometimes 
indicated, since in the early attacks the cause of the pain may be 
suspected to be the presence of indigestible food. 

The treatment required in the intervals between the attacks must 
vary with the cause and with the general condition of health. A 
careful search must be made for the real cause of the trouble, and 
when found it must be removed or palliated by appropriate measures. 

The diet should be carefully regulated, and all the hygienic details 
of the patient's life be critically studied and directed. The avoidance 
of improper food, the abandonment of tea, coffee, and tobacco, the 
prescription of proper dress, exercise, or change of residence, may be 
followed by marked improvement in general health and by a cessa- 
tion of the attacks of gastralgia. 

In regard to remedies it may be premised that all depressing drugs 
must be avoided, as well as all purgatives which would weaken the 
digestion. Any marked disturbance of digestion should be corrected ; 
and this may require the use of pepsin or of some tonic remedies, 
such as are suggested in the article on Indigestion. The chief 
reliance is, however, to be placed upon the administration of arsenic 
and iron immediately after meals, in proper form and doses. Thus, 
we may direct, 

R=. — Liquor potassii arsenitis f: £j (4.0). 

Yini ferri amari . . q. s. ad ffiv (128.0). — M. 

S. — From 30 to 60 minims (2.0-4.0) in Avater after meals, three times daily, for a child 
of six years, or twice this quantity for an adult. 

Or, 

R.—Tincturfe ferri chloridi f^j (32.0). 

Acidi hydrochloric! dilutij aa flss (16.0).-M. 

Liquor acidi arsenosi J J v 

S. — From 4 to 20 drops (0.2-1.3) in water after meals, three times daily. 

Occasionally even better results are secured by the use of cod-liver 
oil in emulsion with hypophosphites. 

The solution of bromide of strontium (Paraf-Javal) is a valuable 
one in gastralgia in the dose of a tablespoonful (16.0) three times a 
day. 

It is well, in cases where the pain is very severe, to combine with 
the above a powder of bismuth subnitrate and saccharated pepsin, 
given about an hour or an hour and a half after meals. Consti- 
pation, should it exist, must be overcome by proper diet, massage, 
enemata, or by suppositories of gluten or glycerin or soap. If the 
use of bismuth favors the continuance of constipation too decidedly, 
small doses of cyanide of potassium, dilute hydrocyanic acid, or 
chloroform may be substituted at the same hours. In cases where a 
highly neurotic state exists, it may be necessary to alternate all other 



520 DISEASES. 

treatment with the bromides or with the preparations of valerian, or 
the following prescription may be used : 

R. — Acid, hydrocyanic, dil f.^j (4.0). 

Ext. cannab. indicse f^j (4.0). 

Tr. hyoscyam f^j (4.0). 

Spt. chloroformi f^ij (8.0).— M. 

S. — 30 minims (2.0) t. d. in water for an adult. 



GASTRIC CATARRH (ACUTE). 

By far the most important point in the treatment of acute gastric 
catarrh is the regulation of the diet, and the following abstract from 
the article written by the author for the third volume of Keating's 
Cyclopaedia of Diseases of Children embodies so thoroughly the ideas 
which the writer desires to express that he has inserted it here : The 
dietetics may be divided into two parts — first, the regulation of the 
food during convalescence or during the attack, and, second, the cha- 
racter of the food to be used during the interval following one attack 
and preceding the next. Total abstinence from food in the acute 
stages of the attack, and absolute bodily and mental quietude, are 
advisable. There are several reasons for this. In the first place, 
the juices of the stomach are in an abnormal state and unfit to act 
properly if the stomach receive more food. Secondly, the mucous 
membrane of the stomach is already hypersemic from the inflamma- 
tion, and, as the normal viscus becomes physiologically hyper^emic 
on the ingestion of food, we would add to the congestion of the blood- 
vessels did Ave alloAvmore nourishment to enter the stomach. Last of 
all, the excess of the mucus and lactic and butyric acids present ren- 
ders any new food impure before it can be assimilated, and so pro- 
longs the trouble. As the attack passes off small amounts of food 
may be given which should be of a kind readily digested and not likely 
to become easily decomposed or rendered acrid by the mucus in the 
stomach. Milk with a large percentage of lime-water is to be used, 
since the alkali not only prevents a too firm coagulation, but also 
decreases the secretion and acid reaction of the mucus. The thirst 
is often excessive, although anorexia is complete, and small pieces of 
ice may be administered for its relief. Commonly it will be found 
that the patient rapidly improves up to a certain point, then stops 
improving or relapses. This is sometimes due to an accumulation of 
mucus, which w T hen mixed with food causes it to undergo fermentation. 
If marked evidences of the presence of this secretion are given, a mild 
and gently-acting emetic may be employed to dislodge the fermenting 
mass. In other instances the relapses depend upon a tendency to a 
condition of atony, which can only be overcome by prolonged and 
careful treatment adapted to the improvement of the general health. 
Sodium bicarbonate with compound infusion or compound tincture of 
gentian may be used during convalescence, and small sips of effer- 
vescing draughts are useful. If constipation exists and vomiting for- 
bids the use of the ordinary purgatives, a Seidlitz powder divided 



GASTRIC CATARRH. 521 

into fourths or fifths, and taken in this way every fifteen minutes or 
half-hour, will settle the stomach, move the bowels, and often carry 
away mucus. 

If there is much epigastric distress, a spice poultice is often of 
service. 

Sweets and starches are to be rigidly denied the patient. If anae- 
mia exists, iron may be used, but this is rarely needed. 

The abdomen should be carefully protected with flannel, and 
draughts and unsanitary surroundings avoided. 

The use of pepsin and of hydrochloric acid is to be much more 
thoroughly attended to than has heretofore been the custom. As a 
rule, we are apt to forget that pepsin acts largely by catalysis, and 
that it is not secreted as pepsin, but as pepsinogen, a substance which 
is changed into pepsin in the presence of an acid. For this reason 
hydrochloric acid should be freely employed unless the inflammation 
is acute, and pepsin given in large or small quantity according as 
there is reason to believe this ferment to be in normal or abnormal 
amount. Common salt (sodium chloride) is virtually identical in its 
ultimate influence with hydrochloric acid, and should be always used, 
in moderation, with the food. 



GASTRIC CATARRH (CHRONIC). 

Chronic gastric catarrh is a condition of the stomach commonly 
seen in this country in a more or less active form. It is often asso- 
ciated with much indigestion and the eructation of sour liquids, or 
even with active vomiting. The secretions of the stomach are nearly 
always abnormal, and fermentative changes are constantly present in 
the gastric contents. 

By far the best treatment for this condition is the use of counter- 
irritation over the epigastrium, the close regulation of the diet, and 
the use, internally, of nitrate of silver and extract of hyoscyamus, 
or, if any hyperacidity exists, the administration of the subnitrate of 
bismuth. Often, however, the better remedy is bicarbonate of sodium 
in the dose of 5 to 20 grains. In many instances the patient will be 
greatly benefited by the use of a Seidlitz powder or Carlsbad salt * 
or Saratoga Carlsbad water before breakfast each morning, as this 
washes out the stomach, dissolves the mucus, and unloads the mucous 
membrane of its congestion, at the same time overcoming any engorge- 
ment of the liver. Constipation is nearly always present, and should 
be removed by appropriate drugs, such as cascara sagrada, of which 
the best preparation is the fluid extract, rendered free from bitter 
taste by certain large manufacturers in this country, such as Parke, 
Davis & Company, or in the form of cascara sagrada cordial. 

All fats, rich foods, strong meats, ham, bacon, or fried things are 
to be avoided, and only light broths, koumyss, or matzoon resorted 

1 Artificial Carlsbad salt may be ordered, composed of 8 ounces of sodium sulphate, 
h an ounce of sodium chloride, and 1 ounce of sodium carbonate. The dose varies 
from 2 drachms to i an ounce (8.0 16.0). 



522 DISEASES. 

to if the case be an obstinate or severe one. A nitrate-of-silver pill 
should be used half an hour before each meal, and be prescribed 
as follows : 

R. — Argenti nitratis gr. iv (0.2). 

Extract, hyoscvami gr. x (0.65). — M. 

Ft. in pil. No. xx. 
S. — One, half to one hour before each meal. 



GASTRIC DILATATION. 1 

The treatment of dilatation of the stomach may be divided into 
two varieties — the first consisting of the methods of cure which are 
directed against the diseased state of the gastric Avails themselves ; 
the second, of those methods by which abnormal changes in the food 
and the' gastric contents and secretions are combated, thereby allow- 
ing reparative changes to take place. As is well known, dilatation 
of the stomach may be dependent upon some constitutional or some 
local cause. If the cause be rickets, it is evident that the nutri- 
tion of the bony system and of the system in general is to be im- 
proved, and that remedies devoted to this object are to be given, such 
as cod-liver oil by inunctions, or. if the digestive apparatus will bear 
it, the oil may be given by the stomach. Lactophosphate of lime, 
phosphate of sodium, or iron, often in the form of the syrup of the 
iodide, should be used if any signs of struma are present. Good 
foods possessing large amounts of salts, yet easy of digestion, are 
under these circumstances particularly desirable, and by far the larger 
part of the treatment should be directed to the dietetics of the case. 
Of this the writer will speak farther on. 

There are several means to be employed for the relief of gastric 
dilatation other than those which can be called medicinal, so far as 
drugs are concerned. 

These consist, first, in efforts to evacuate the stomach and to cleanse 
it (see Lavage, Part III.) ; secondly, in attempts by these and other 
means to prevent its distention by the gases which arise or by the 
accumulation of ingesta which takes place ; thirdly, in the regulation 
of the diet so as to avoid causes which have a tendency to increase 
the disorder. 

Dilatation of the stomach is so difficult to cure that very satis- 
factory results are not to be looked forward to ; nevertheless, the 
nutrition and the general state of heath are to be carefully con- 
sidered. 

The treatment of dilatation to be first considered is dietetic. There 
can be no doubt that one of the chief reasons for the emaciation which 
comes on is the failure on the part of the stomach to digest and 
assimilate nourishment. In addition to this, the intestine is really 
the place for absorption of food to take place, and the delay of the 
food in the stomach virtually makes the chyme unfit for the function 
of the small intestine. 

The foods to be given are, of course, to be in the highest degree 

1 See article by author in Keating' s Cyclopaedia of Diseases of Children, vol. iii. 



GASTRIC ULCER. 523 

capable of ready assimilation, and should be confined, especially in 
severe cases, to the materials which we can readily predigest by the 
employment of the digestive ferments now so largely sold. Carefully- 
skimmed milk is valuable, aside from its inherent usefulness, in that 
it lacks the fats, which can be utilized only in the intestines, and 
which simply break down and decompose if kept in the stomach. 
Oyster broth, carefully freed from any oily matters in cooking and 
thoroughly pancreatized, is to be given. Ordinary whey obtained 
from milk by means of rennet is useful. 

Rectal alimentation to some degree is always useful, and Ewald of 
Berlin suggests the following nutrient enema : Beat up two eggs with 
a tablespoonful of cold water ; to this add a little starch, boiled in 
half a cupful of a 20 per cent, solution of grape-sugar and a wine- 
glassful of red wine. The solution is to be well mixed at a tempera- 
ture not high enough to coagulate the albumin, and injected as high 
up into the bowel as possible. For a child this mixture should be 
somewhat less in quantity than that given for the adult, particularly 
as to the wine. 

An exceedingly important part of the dietetic treatment of gastric 
dilatation consists in the constant bearing in mind of the fact that the 
tendency of food is to accumulate, and the avoidance of the pernicious 
habit of adding solids or liquids to the quantity of ingesta still remain- 
ing from a previous meal. If the child is old enough, all the remains 
of previous feedings should be removed by lavage before anything 
more is given, since otherwise the sweet food is at once contaminated 
by the liquids which it meets in the stomach. 

The medicinal treatment of gastric ectasy is, unfortunately, very 
limited, so far as the stomach itself is concerned, and, indeed, we doubt 
whether any direct medication can ever be of much value unless in 
the form of disinfectant substances, such as we have spoken of when 
speaking of lavage, and these only prevent decomposition of the food 
and do not effect a cure. 

In a case of marked gastric dilatation we should, nevertheless, 
always resort to the bitter tonics, such as gentian or calumba, and for 
the improvement of the muscular coats of the viscus should employ 
the tincture or extract of physostigma in the dose of 5 to 10 drops 
(0.3-0.65) or 1 to \ grain (0.005-0.01), respectively. In the case of a 
child under the author's care a very extraordinary improvement fol- 
lowed the use of this drug and the careful fulfilling of all the direc- 
tions just given except the lavage, which was not employed. 

Another remedial measure which has been comparatively recently 
introduced is the faradization of the gastric walls by an internal and 
external electrode made for this purpose by electricians. 



GASTRIC ULCER. 

In the treatment of gastric ulcer three points must be borne in 
mind as being essential. These are, rest for the stomach as far as 
possible, rest for the patient, and the maintenance of the gen- 



524 DISEASES. 

eral health. The first of these points involves a consideration of 
diet. If in any case the stomach is very irritable, it is best to place 
the patient in bed and nourish her for from two to eight days by means 
of enemata. Probably the best form of nourishment for this purpose 
is a mixture recommended by Dreschfeld, and consisting of 2 raw 
eggs with 2 ounces (64.0) of beef-tea and a little brandy, which may 
amount to 1 ounce (32.0) if the patient really needs stimulants. It 
may be well to place a little pepsin in this injection to peptonize the 
proteids, but if this is done the alcohol must be left out, as it will 
interfere with the activity of the pepsin. Pancreatin may also be 
used with advantage in some cases in the amount of 5 or 10 grains 
(0.35-0.65) in each injection. For the relief of thirst, which may 
be excessive if rectal alimentation is resorted to, the patient should 
hold in the mouth small pieces of ice or drink moderate quantities 
of barley- or rice-water. After this treatment has been used for some 
days, small quantities of food may be given by the mouth, such as a 
little peptonized milk or a little warm milk with lime-water in the 
proportion of half and half, or 1 part lime-water to 2 of milk. After 
this thin arrow-root or gruel may be given in moderate quantity. It 
is better to give the food in small amount every two hours than in 
larger quantity three times a day. The increase in rations, both as 
to variety and amount, should be most gradual, the physician extend- 
ing the dieting over at least six weeks, of which the first two had best 
be spent in bed. It is well to use massage and electricity under these 
circumstances to preserve nutrition, as in the rest cure. (See Rest 
Cure.) Beef-tea and soups had better be avoided during the early 
stages of the treatment, as they will irritate the stomach. Soft-boiled 
eggs, tender chicken or game, and minced lamb may be finally given. 
Cheese, coffee, tea, beer, and ale are to be avoided, as are al] hot 
drinks. Fresh green vegetables may be used in moderation, but fresh 
bread and unripe fruit must be carefully avoided. When milk is 
taken it should be warmed. The presence of gastric pain indicates 
that the diet must be cut down in quantity and the nutrition main- 
tained solely by rectal injection. 

The drug treatment of these cases is both palliative as to pain and 
curative. For the pain counter-irritation of a more or less severe and 
constant type should be applied to the epigastrium, either as a spice 
or mustard plaster or by means of a hot-water bag. The counter- 
irritation should be as continuous as possible. Sodium bicarbonate and 
the subnitrate and subcarbonate of bismuth are also of service in the 
dose of 20 grains (13) each, and to these may be added from -^V to J- 
of a grain (0.003-0.015) of morphine hydrochlorate or 1 grain (0.05) 
of codeine. These may be given thrice daily if necessary. Only the 
smallest dose of morphine necessary to relieve the pain should be 
employed. By far the best treatment for the pain and for the ulcer 
itself is the following pill : 

R. — Argenti nitratis gr. iv (0.2). 

Extracti hyoscyami gr. x vel xx (0.65-1.3). — M. 

Ft. in pil. No. xx. 
S. — One pill half to one hour before meals. 



GASTRITIS. 525 

For the constipation which is frequently present the patient may 
receive a dose of Carlsbad salts or phosphate of sodium, or even the 
sulphate of magnesium. 

For the relief of vomiting and of haematemesis absolute abstinence 
from food, so far as its administration by the mouth is concerned, is 
to be insisted upon. Nutrition must be maintained under such cir- 
cumstances by the rectum. Small doses of \ grain (0.015) of cocaine 
may be given, or cocaine and bismuth subnitrate together if the vom- 
iting is persistent. Sometimes drop doses of creasote are useful, or 
carbolic acid may be given in the same dose with 20 grains (1.3) of 
subnitrate of bismuth. One of the best remedies for hsematemesis is 
oil of turpentine in the dose of 5 to 10 drops (0.35-0.65) four times 
a day. In other cases good results will often follow the use of the 
solution of the subsulphate of iron (Monsel's solution) in the dose of 
3 drops (0.15) every half-hour or by the employment of 3 grains (0.15) 
of the salt itself in pill. Cold compresses or an ice-bag should be 
applied to the epigastrium. 

Should perforation of the stomach occur, the prognosis is most 
gloomy unless inflammatory processes protect the peritoneal cavity, 
as often occurs. The tendency to peritonitis should be antagonized 
by the application of cold to the belly-wall, by the avoidance of food, 
by perfect physical rest, and by supportive treatment in the way of 
heat to the limbs and the hypodermic use of ether, brandy, or 
ammonia. Morphine should also be given freely unless collapse is 
too pronounced, as it tends to prevent abdominal pain and inflam- 
mation. Operative measures are to be resorted to in suitable cases. 

GASTRITIS (ACUTE). 

This is generally due to the ingestion of irritant foods or drinks, 
rarely arising in its true acute form from other causes. 

The treatment is to be directed entirely to the prevention of the 
spread of the inflammation and to the relief of that already devel- 
oped. If the patient is seen soon after the onset of the trouble, the 
stomach is to be emptied of all irritant substances by means of vom- 
iting induced by large draughts of warm water, or, better still, by the 
use of the stomach-pump, as the retching may increase the irritation. 
Mucilaginous drinks are to be given freely, and albuminous materials 
seem especially useful. Oils and similar protective liquids aid in 
preventing further damage. Opium, to allay pain and the local and 
systemic irritation, is invaluable. This drug should always be given 
in liquid form, and the deodorized tincture is the best in this respect, 
owing to its freedom from narcotine. Paregoric contains too little 
opium to be of value, and is irritating because of its volatile oil. If 
the stomach will not retain drugs, they should be given by the rec- 
tum. If evidences of collapse appear, hot applications, atropine, or 
belladonna should be exhibited. It is important that the heat 
should be applied over the epigastrium and chest, and a flaxseed poul- 
tice is the best method of doing this. Practically, the same rules hold 
good in regard to diet in both acute gastritis and in gastro-enteritis. 



526 DISEASES. 



GASTRO-ENTERITIS. 



Gastroenteritis is a condition of inflammation affecting the entire 
alimentary canal in some instances, and commonly produced by the 
ingestion of some irritant substance, either in the form of bad food, 
poisons, or mechanical irritants, such as grape-seeds or cherry-stones. 
The symptoms accompanying it are exceedingly various, but consist 
chiefly in pain of a griping character with watery or mucous stools, 
or, if the inflammation be very severe, absolute and unyielding con- 
stipation may be present. The nervous symptoms depend upon the 
degree of irritation and the general nervous tendency of the patient, 
and if the trouble is very severe he may go on into a condition of 
shock or collapse. 

If the irritation is very intense, exfoliation of the mucous mem- 
brane may take place, the epithelium coming away in shreds. 

The treatment of gastro-enteritis depends upon its severity and 
cause. Almost always we first allay the pain and tendency to inflam- 
mation by the hypodermic use of morphine, and immediately follow 
this or precede it by an emetic of a non-irritating and rapidly-acting 
type, such as apomorphine, provided there is reason to believe that 
the poison or food still remains in whole or in part in the stomach. 
If the irritant has been taken some time before the physician is called 
in to see the case, emetics are contraindicated, as by disturbing the 
abdominal contents they render the inflammation worse. Following 
this, or in place of it if emetics are not useful because the poison has 
already passed through the pylorus, castor oil in the dose of 2 to 3 
tablespoonfuls (32.0-48.0) to an adult may be given to sweep out the 
offending materials and lubricate the intestinal walls. In other cases 
sulphate of magnesium may be used, but not sulphate of sodium or 
Rochelle salt, as they are both irritant. The sulphate of magnesium 
is of value, because, in addition to its purgative effect, it also depletes 
the inflamed bowel. Having gotten rid of all offending materials, 
opium and sulphuric acid are to be freely used to allay irritation and 
control diarrhoea (see Diarrhoea), and hot compresses are to be applied 
to the belly, or a spice or mustard plaster used instead. Vomiting 
when it is excessive is to be treated in the manner described under 
that head. The after-treatment of acute gastro-enteritis is very im- 
portant, both in respect to food and drugs. The inflammatory pro- 
cess, if severe, will have interfered with or destroyed glandular action 
to such an extent that starvation from the non-assimilation of food 
may occur. Predigested foods are therefore in many cases indis- 
pensable, and a carefully regulated diet a sine qua non. 



GLAUCOMA. 

Glaucoma, or that disease dependent upon an increase of intra- 
ocular pressure, appears in an acute or a chronic form. The disease in 
general terms is characterized by halos appearing about the gas-light ; 
periods of obscuration of sight ; shrinking of the nasal half of the 



GONORRHCEA. 527 

field of vision ; narrowing of the anterior chamber of the eye ; anaes- 
thesia of the cornea ; and increased tension of the eyeball. In the 
" glaucomatous attack," or acute glaucoma, the injection of the eye- 
ball is intense ; the lids swell, there is photophobia, the cornea is 
steamy, the pupil dilated and motionless, and the vision rapidly 
destroyed. The case may be mistaken for iritis or acute ophthalmia 
— a fatal blunder. 

Iridectomy or an equivalent measure is the only treatment for 
glaucoma, If for any reason this is delayed, a solution of the sul- 
phate of eserine, 1 to 2 grains to the ounce (0.05-0.1 : 32.0), or pilo- 
carpine nitrate in twice this strength, should be dropped into the eye 
every two or three hours until relief follows. Atropine must not be 
employed. Hot compresses, opiates, and leeches are also useful to 
alleviate the pain if for any reason operation is delayed. 



GONORRHCEA. 

The therapeutics of urethritis varies in accordance with whether 
the disease is acute or chronic, and is very greatly modified by the 
seat of inflammation — a posterior urethritis, for anatomical and 
mechanical reasons, not being amenable to the same treatment which 
will prove successful when the disease invades the penile portion of 
the urethra. 

The membranous and prostatic portions of the urethra constitute 
its posterior part. They are surrounded by layers of powerful mus- 
cles which keep the canal constantly occluded and which play the 
part of vesical sphincters. Hence any injection forced into the 
urethra passes to, but not beyond, its membranous part, and is worse 
than useless if administered with the intention of combating inflam- 
mation of the posterior urethra. It is the rare exception for gonor- 
rhoea to be confined to the anterior urethra. Usually it extends back, 
and a common cause of gleet is failure to recognize this fact, and con- 
sequently the omission of measures calculated to cure the deep inflam- 
mation. 

Since the general acceptance of the gonococcus as a specific cause 
of gonorrhoea the treatment of acute anterior urethritis has been 
mainly antiseptic, those drugs being chosen which are found to act 
most powerfully upon the specific germs, and at the same time pro- 
duce the least irritant action upon the mucous membrane. Bichloride 
of mercury, as representing the most powerful germicide known to 
medicine, has been used most extensively. The main objection to its 
action lies in the fact that when employed in efficient strength it is 
exceedingly irritating. This effect may, to some extent, be avoided 
by using a large quantity in dilute solution, and one of the most sat- 
isfactory treatments yet advocated consists in thoroughly and repeat- 
edly flushing the urethra with bichloride lotion, 1 : 20,000 or 1 : 
40,000. This may be accomplished by means of a bulbous catheter 
provided with numerous small apertures opening backward just behind 
the enlarged extremity ; immediately after urination the bulb is car- 



528 DISEASES. 



ried to the membranous portion of the urethra; the tube from an irri- 
gator is then attached to the extremity of the catheter, and one or 
two pints of dilute mercury solution, as hot as can be borne, are 
injected. This may be repeated once or twice daily. When the 
urethra is so sensitive that the passage of an instrument is not prac- 
ticable, a conical nozzle of a size to close the meatus entirely when 
inserted may be employed for irrigation. After first thoroughly 
washing the glans and lips of the meatus the nozzle should be inserted 
and held firmly in place. This ensures the passage of the injection 
back as far as the membranous portion of the urethra, beyond which 
it will not pass if the pressure does not exceed that obtained by ele- 
vating the irrigator two feet above the level of the urethra. When 
neither of these methods of irrigation can be practised, a syringe 
with a conical nozzle and with a capacity of at least 1 ounce may be 
employed : this should be used two to six times a day, two syringe- 
fuls of the dilute lotion being injected immediately after urination. 
The liquid should be forced in very gently, being allowed to flow out 
by slightly lessening the pressure of the nozzle upon the meatus when 
the anterior urethra is full. When large injections are attempted by 
the ordinary small urethral syringe, the frequent application of the 
latter to the meatus occasions much irritation. It is desirable that 
the injection should pass back into the posterior urethra, since this 
portion of the canal is usually involved in acute inflammation. 

Copious irrigations inaugurated in the earliest stage of gonorrhoea 
are frequently successful in producing a complete cure in a few days. 

Much stronger solutions of mercury are frequently employed, the 
concentration depending upon the subjective sensations of the patient, 
and varying from 1 : 2000 to 1 : 6000. 

The following prescriptions are among the most efficacious in 
checking the discharge : 

R —Argent, nit gr. ss (0.025). 

Aq. destil. . . ^ |iij (96.0).— M. 

S. — Locally in the subsiding stage. 

R.— Ext. hydrast (colorless) f^iv (16.0). 

Bismuth, sublact 3yj (24.0 s ). 

Glycerin f^iv (16.6). 

Aq q. s. fjfvj (192.0).— M. 



I 



R. — Zinc, sulph. 

Acid, carbol. [- aa gr xij (1.0). 

Alum. crud. 

Aq. destil. . . f^vj (192.0).— M. 

S. — Locally. Dilute if painful. 



When the gonorrhoea has already assumed a markedly inflamma- 
tory type, with swelling and oedema of the penis, redness and ever- 
sion of the meatus, and great sensitiveness of the urethra, no injec- 
tion should be employed. The penis should be wrapped in cloths 
kept wet with alcohol and water or lead-water and laudanum. With 
the subsidence of acute inflammatory symptoms and the appearance 
of copious discharge the injection treatment may be inaugurated. It 



GONORRHOEA. 529 

must be remembered that injections may in themselves prevent the 
discharge from entirely disappearing. Hence, as the symptoms ame- 
liorate the injection should be made less frequently, finallv being 
entirely omitted for some days if the discharge seems to continue 
longer than usual. 

Internal medication and constitutional treatment are most import- 
ant in all forms and stages of gonorrhoea. It is almost universally 
accepted that certain drugs, such as copaiba, cubebs, and oil of san- 
dalwood, when eliminated through the kidneys, possess the power of 
inhibiting the growth of the gonococci or of destroying their vitality. 
Bacteriological research has shown that of this class of remedies 
copaiba alone possesses such power. To this drug may be added 
salol, which has been proved by laboratory and clinical tests to exert 
a powerful germicidal action upon the gonococcus. Clinical experience 
has shown that oil of sandalwood is of great value in the treatment 
of acute gonorrhoea. An excellent formula for the administration of 
balsams is the following : 

R.— 01. santal gr. v (0.3). 

Balsam copaib tt\,v (0.3). 

01. cinnamom TT\j (0.05). — M. 

Encapsulate. 
These capsules should be taken one hour after meals, from six to twelve being admin- 
tered. 

Obstinate chordee may require bromide of potassium and chloral. 
Of these a drachm of the former must be given at bed-time, and 10 
grains of the latter; this may be repeated in the night if painful 
erections persist. Lupulin in 30-grain (2.0) doses is also endorsed. 
AVhen practicable, opium or belladonna suppositories, or hypodermic 
injections into or about the perineum of morphine gr. J (0.015) and 
atropine gr. -g 1 ^ (0.001), will prove very satisfactory. In all cases the 
patient should be instructed to rise once during the night and pass 
his water. 

Ardor urince is usually relieved by the use of demulcent drinks 
and by the employment of bicarbonate of sodium or citrate of potas- 
sium in sufficient doses to render the urine but slightly acid. Either 
of these drugs is conveniently administered in the form of compressed 
tablets, taken one or two hours after meals in 10-grain (0.65) doses, 
the quantity being increased, if necessary, until the desired effect is 
produced on the urine. The instillation into the urethra, by means 
of an eye-dropper, of a 4 per cent, solution of cocaine a few minutes 
before urination markedly diminishes the burning. Finally, this 
symptom may often be relieved by instructing the patient to pass his 
water with the penis submerged in a vessel containing water as hot as 
can be borne. 

Where the inflammation is of a high grade and attended by fever 
and general malaise, the administration of 2 drops (0.1) of aconite 
repeated every two or three hours is followed by marked relief. 

In regard to the general treatment of a patient suffering from 
gonorrhoeal urethritis rest in bed is particularly desirable. This, 
however, is rarely possible, and the surgeon must be content with 

34 



530 DISEASES. 

enforcing the avoidance of all active exertion and the observance of 
as much rest of mind and body as is compatible with the continuance 
of the daily routine of business life. While skimmed milk or butter- 
milk diet is theoretically desirable, the advantages to be gained by 
it are scarcely sufficient to justify insistence upon such a regimen, 
especially as it would excite suspicion as to the presence of venereal 
disease; hence a light diet, consisting mainly of vegetables and fruits, 
and in quantity about half that usually taken, with a minimum amount 
of meat, should be advised, In addition the patient should be induced 
to drink liberally of plain water or any of the sparkling mineral 
waters, as by this means the urine is not only rendered bland, but 
greatly increased in quantity, thus enabling the urethra to be fully 
Hushed from behind many times a day. Flooding of the stomach 
with such large quantities of liquids as to produce dyspepsia is to be 
carefully avoided. It is scarcely necessary to state that copulation or 
any form of venereal excitement must be strictly interdicted. Finally, 
prolonged warm baths lasting from half an hour to two hours seem 
to exert a favorable influence upon local inflammation. 

Acute posterior urethritis does not usually develop until the dis- 
ease of the penile portion of the urethra has run a course of two or 
three weeks. During the very acute symptoms local treatment applied 
to any portion of the urethral canal probably aggravates the condi- 
tion, and even the internal administration of balsams and antiseptics 
must be employed with very great caution, their use being suspended 
at once if the inflammation seems to be aggravated by their employ- 
ment. Hence, when in the third week of gonorrhoea there is a violent 
outbreak of inflammation in the membranous and prostatic portions 
of the urethra, suspension of all active treatment is indicated. The 
bowels are kept open ; the diet is carefully regulated ; the urine is 
rendered bland, unirritating, and antiseptic ; continued warm baths 
are ordered, the painful symptoms being controlled by opium and 
belladonna, administered either hypodermically or in the form of a 
suppository. When the acute symptoms subside the quantity of anti- 
septics taken by the mouth may be increased, balsams may be added, 
and local treatment may be directed first to the posterior urethra, after 
the cure of which the anterior urethritis should receive attention. It 
has been stated already that injections forced into the meatus rarely 
penetrate beyond the bulbous portion of the urethra ; hence to influ- 
ence the deeper portions of this canal some other method of apply- 
ing these drugs must be devised. This end is best accomplished by 
means of Ultzmann's irrigation catheter or other instrument similar 
in principle. 

The patient is first instructed to empty the bladder of a portion of 
its contents ; by this means the urethra is flushed out. The catheter 
is then introduced into the membranous portion of the canal, and by 
means of a syringe 1 ounce (32,0) of the injection is forced into the 
membranous and prostatic portions of the urethra. This fluid does 
not regurgitate along the sides of the catheter, but enters the bladder, 
and is passed with the urine at the next act of micturition. The 



GONORRHOEA. 531 

injection most employed is the following : Nitrate of silver, grain \ 
to 1 (0.015-0.05); distilled water, gj (32.0); carbolic acid, 1 grain to 
the ounce. Any of the injections used in anterior urethritis may also 
be then employed. These injections should be made twice a week. 

Chronic Gonorrhoea. 

Chronic gonorrhoea differs from the acute form in the fact that the 
inflammation is distinctly localized in certain portions of the urethra, 
and does not invade the whole canal w T ith uniform intensity ; hence, 
efficient treatment must be directed not to the whole urethra, but to 
the diseased areas. Foci of chronic urethritis are usually found 
either in the bulbous portion of the urethra or in the membranous or 
prostatic portion. If the disease is located in the anterior urethra, 
it will commonly be found to depend upon the existence of a struc- 
ture of large calibre. The passage of sounds of full size — cutting 
the meatus if this is necessary for their introduction — will be followed 
by prompt relief in such cases. The sounds should be used not more 
frequently than twice a week, and should be most carefully sterilized 
before introduction. 

If after free dilatation the discharge still persists and a large por- 
tion of the anterior urethra is in a catarrhal condition, as shown by 
examination of the urine, irrigation of the urethra should be prac- 
tised. This may be best effected by passing a soft-rubber catheter 
down to the membranous portion of the urethra, and injecting through 
it once daily 3 ounces (96.0) of a J-grain-to-the-ounce (0.025 : 32.0) 
solution of nitrate of silver. When the general catarrhal condition 
is materially modified, by means of an ordinary hard-rubber endo- 
scope and a head-mirror, the focus of inflammation may be exposed, 
and may be treated directly by strong astringent solutions carried 
in by means of a brush or by absorbent cotton secured to the extrem- 
ity of a long applicator. Nitrate of silver or sulphate of copper, 20 
grains to the ounce (1.3 : 32.0), may be employed. Unna has 
devised a most successful treatment for obstinate cases of gonorrhoea. 
He advises coating the sounds with the following mixture : 

R.— 01. cocse ^iij (96.0). 

Cerse flav ^ss (2.0). 

Argent, nitratis gr. xv (1.0). 

Balsam. Peruvian .^ss (2.0). — M. 

This is liquefied in a water-bath ; the sounds are dipped in it and are 
then hung up to dry. On being passed the heat of the body melts 
the coating. The objection to their use lies in the fact that the appli- 
cation is made to the entire urethra. Practically, however, their 
employment is often followed by brilliant results. 

Chronic posterior urethritis must be treated by remedies applied 
directly to the diseased area. Nitrate of silver is more commonly 
successful than any other medication. By means of Ultzmann's 
apparatus 3 or 4 drops (0.25-0.3) of a solution varying in strength 
from 0.1 per cent, to 5 per cent, may be employed. 



532 DISEASES. 

Finger recommends the following ointment : 

Be. — Argent, nitratis vel cupri sulph gr. xv (1.0). 

Lanolin giij (96.0). 

01. olivae £jss (6.0).— M. 

By means of an ordinary catheter — which is first filled, then intro- 
duced until its eye reaches the prostatic portion of the urethra — a 
definite quantity of the ointment can be forced into the canal by a 
graduated rod. 

In many cases pressure will exert a curative action, causing prompt 
absorption of inflammatory effusion. To accomplish this result large 
sounds may be passed into the bladder. Frequently the therapeutic 
influences of cold, together with pressure, are found beneficial. The 
best means of combining these two remedies is found in the psychro- 
phore, an instrument in the shape of a sound, but so arranged that a 
stream of water flows through its interior. 

It must be borne in mind that chronic gonorrhoea is commonly due 
to unskilful or not sufficiently prolonged treatment of the acute stages. 
Not only should the treatment of acute gonorrhoea be continued until 
the gonococci have entirely vanished, but for fully two weeks after 
the disappearance of all symptoms of inflammation. The same rule 
holds good in regard to the chronic manifestations of the disease. 
Only after careful examination of the urine fails to show any sign of 
inflammatory trouble for at least two weeks should the treatment be 
suspended ; and this should not take place suddenly, but the intervals 
between the applications be gradually increased in length, the patient 
being carefully watched in the mean time. 

Per contra, it must not be forgotten that long-continued irritant 
treatment may in itself indefinitely prolong a urethral discharge. 
Hence it is wise to suspend all injections in certain cases, and to 
examine the discharge carefully, as found in the urine, to determine 
whether or not the continuance of symptoms is dependent upon this 
cause. 

There is a mucous secretion which quite frequently follows gonor- 
rhoea, but which is in no way dependent upon the persistence of this 
disease. Microscopic examination will at once determine its nature. 
It is probably most rapidly cured by attention to general hygiene and 
by tonic and supporting treatment. 

Complications of Gonorrhoea. 

Among the many local and general complications which may occur 
in the course of an acute or subacute gonorrhoea are balanitis, balano- 
posthitis, prostatitis, and epididymitis. 

Balanitis and balano-posthitis are treated by perfect cleanliness. 
The discharge must be thoroughly washed out, and the surface miisfc 
be dried and isolated. The thorough cleansing of the parts is best 
accomplished by weak astringent solutions, such as the chloride of 
zinc, 4 grains to the ounce (0.2 : 32.0), 1 per cent, boric acid, or 1.5 
per cent, carbolic acid ; nitrate of silver is particularly valuable, and 
in the proportion of 1 grain to the ounce (0.05 : 32.0) will be found 



GONORRHCEA. 533 

sufficiently strong for use as a wash or injection. The superficial 
ulcerations may be further touched with the solid stick of the nitrate 
of silver. The prepuce having been retracted and the parts having 
been thoroughly washed, dusting powder, such as tannin or oxide of 
of zinc, is distributed over the surface of the inflamed parts ; the glans 
is then covered with a thin layer of absorbent cotton and the prepuce 
drawn forward. This dressing is to be repeated three times daily. 

If the phimosis is so tight that the prepuce cannot be retracted, 
cleansing, astringent injections, and wrapping the penis in one or 
two thicknesses of gauze or other thin fabric, constantly kept wet 
with dilute lead-water, will be the treatment indicated. If in spite 
of this treatment, inflammatory symptoms become more marked, cir- 
cumcision is indicated. 

Prostatitis rarely develops before the second or third week in the 
course of urethritis. Where the acute symptoms are fairly developed 
direct local treatment is of little avail. Rest in bed, light diet, care- 
ful regulation of the bowels, medication to render the urine bland 
and unirritating, elevation of the pelvis, local depletion by means of 
leeches applied to the perineum, and the administration of morphine 
and belladonna, either by means of suppository or by hypodermic 
injection, represent the general treatment of all inflammatory condi- 
tions at or about the neck of the bladder. In the great majority of 
cases prostatitis undergoes prompt resolution, and this is more power- 
fully influenced by rectal injections than by any other method of 
treatment. For this purpose a two-way rectal tube must be employed, 
the nozzle of which is directed against the projection of the prostate 
into the bowel. From 2 to 4 quarts (2 to 4 litres) of water, either 
very cold or as hot as can be borne, are allowed to flow into the rec- 
tum by gravity, this arrangement of the tubes allowing the injection 
to flow out as rapidly as it flows in. This treatment should be re- 
peated three or four times a day. When, in spite of careful treat- 
ment and the free use of anodynes and antispasmodics, there is reten- 
tion of urine, a soft cathether should be passed into the bladder and 
allowed to remain there. 

If general and local symptoms denote abscess-formation, the pus 
should be evacuated by perineal incision as soon as its presence is 
positively determined upon. It is true that the pus collection usually 
is spontaneously discharged into the urethra, but this result cannot 
certainly be depended upon, and, at best, is an unsatisfactory termi- 
nation of the trouble. 

When the inflammation runs into a chronic type, the treatment 
suitable for chronic posterior urethritis is indicated — namely, the use 
of large cold steel sounds and local applications to the prostatic 
urethra. In addition rectal injections, by means of the two-way 
tube, are very efficient in producing a cure. 

Epididymitis requires rest in bed, cessation of all local treatment 
directed against the gonorrhoea, the elevation of the pelvis and testi- 
cles, and the systemic treatment applicable to acute inflammation. 
The general tendency of this complication of gonorrhoea is toward 
spontaneous resolution. The testicles may be supported by a hand- 



534 DISEASES. 

kerchief bandage, the base of which is passed beneath the scrotum 
while the ends and apex are secured in front to a circular band pass- 
ing about the waist. To combat the agonizing pain and hasten the 
cure punctures have been advised. These, by relieving tension, 
promptly alleviate the suffering. Ice-bags may also be applied, 
though it is claimed that as a result of this treatment there remains 
an obstinate induration of the epididymis. Local applications of 
the nitrate of silver and of tincture of iodine are also said to act 
beneficially. 

Since it is usually impossible for a patient suffering from gonor- 
rhoea! epididymitis to keep to his bed, a treatment must be devised 
which will allow him to attend to his business, and at the same time 
will prevent the inflammation from becoming aggravated. The part 
must be splinted ; if at the same time uniform pressure can be applied 
the cause of the trouble will be still further favorably modified. 
These indications are complied with, partially at least, by strapping 
the injured testicle. For this purpose a number of adhesive resin 
strips, each half an inch wide and long enough to pass three-fourths 
around the swelled testicle, are cut. The first strip encircles the 
scrotum between the affected testicle and the body, tightly imprison- 
ing the former in a pouch of skin. The succeeding strips are then 
placed, each overlapping the other in such a manner that the entire 
pouch is covered in, and a handkerchief bandage, applied as described 
above, may then be used to elevate the testicle. A better means of 
securing rest and pressure, and at the same time exerting the resol- 
vent influences of heat and moisture, is offered in the dressing pro- 
posed by Horand-Larjglebert. The entire scrotum is first enveloped 
in a thick layer of cotton ; over this is placed a piece of rubber-dam 
sufficiently large to cover in the cotton, and the dressing is completed 
by an ordinary suspensory, gored at the sides and provided with tapes 
to allow of close fitting. Unless there be decided swelling of the 
spermatic cord, this dressing usually allows the patient to attend to 
his business, and is followed by as prompt resolution as though con- 
finement to bed had been insisted upon. When the acute symptoms 
have disappeared attention must be directed to the removal of infil- 
tration, which if it persists may be a cause of sterility. This is 
accomplished by the continuance of heat, moisture, and pressure ; by 
local applications, such as iodine gr. iv (0.25) in lanolin 5J (32.0), or 
of equal parts of mercury ointment and belladonna ointment, or by 
ichthyol, with lard half and half, and by the internal administration 
of iodide of potassium, 10 to 20 grains (0.65-1.3) three times daily. 

Gonorrhoea in the Female. 

The symptoms of acute gonorrhoea in the female are usually so 
mild that the attention of the physician is rarely called to the disease 
until it has reached its chronic form and has invaded the uterus and 
its appendages. When, however, acute urethritis is found, the treat- 
ment, both local and general, is conducted on the same principles as 
when the disease attacks the male urethra. During the most acute 



GOUT. 535 

stage no local treatment is advisable, but subsequently injections can 
be made with the ordinary hard-rubber syringe, not more than a 
drachm and a half of the liquid being employed at a time. If the 
urethral discharge persists, the seats of the suppuration are readily 
found by the endoscope tubes, and treated directly by applications of 
strong solutions of nitrate of silver or sulphate of copper. The 
results of treatment are commonly satisfactory. 

Acute vaginitis is not very frequently observed, excepting in chil- 
dren and young girls. In addition to the general treatment of inflam- 
mation, local treatment directed to cleansing thoroughly the inflamed 
surfaces of discharge and acting upon them by a strong antiseptic 
lotion will be followed by a rapid cure. The patient is instructed to 
irrigate the vagina three times daily with 2 pints (1 litre) of bichlo- 
ride-of-mercury solution, 1 : 4000, thrown in by means of a fountain 
syringe. For this fluid to reach every portion of the diseased mucous 
membrane it is necessary that the patient should lie upon her back 
with the hips elevated. Before rising a pledget of absorbent cotton 
is placed between the labia. During the most acute stage of vaginitis 
hot-water injections and prolonged hot sitz-baths are indicated. In 
addition to the antiseptic irrigations which the patient is directed to 
make, the physician should every second day insert a speculum and 
paint every portion of the diseased mucous membrane with nitrate- 
of-silver solution varying in strength from 4 to 40 grains to the 
ounce (0.25-2.65 : 32.0). The vagina should then be packed with 
tampons of absorbent cotton, which may be dusted with astringent 
medication. 

Vulvitis corresponds to balanitis in the male, and is treated in a 
similar manner. Cleanliness is the most essential point in securing 
a cure. The parts are thoroughly washed with weak antiseptic 
lotions, and the abraded mucous surfaces are kept from coming in 
contact by means of a layer of absorbent cotton or a piece of lint 
soaked in dilute lead-water or other mild astringent solution. 



GOUT. 

Gout is a word used to signify a series of manifestations occurring 
chiefly in those who have led a lazy, sluggish life and have lived 
on the fat of the land, and partaken more frequently of alcoholic 
beverages than of water ; or it occurs in persons who do not live in 
this way, but whose ancestors will be found to have done so, and to 
have handed down to them the gouty taint or diathesis ; or, once 
more, in those who have had poor food for a long time. In other 
words, it is a disorder of nutrition and metabolism. Very few 
Americans have gout in its marked and characteristic forms, owing 
to the active life pursued, and to the fact that the inhabitants of the 
Western hemisphere drink large amounts of water, thereby contin- 
ually dissolving effete matters in the system and washing them away. 

The therapeutic importance of pure water in this state is remark- 
able, and the so-called lithia waters depend for their value more 



536 DJSEASES. 

upon their freedom from salts than their presence. When a patient 
goes to medicinal springs he simply acts as a sluice-way, and by 
continually drinking water washes out the kidneys and prevents 
deposits of calcareous matters throughout the body. In a gouty 
individual the liquids of the body may be said to be so overladen 
with salts that they deposit them wherever a spot is found which is 
easy of access, just as water laden with lime forms a deposit on the 
sides of its bed when a drought comes on, and dissolves and removes 
these formations when a freshet takes place. Very often, when such 
waters are not attainable, satisfactory results will be reached by ordi- 
nary distilled water, the insipid taste of which can be overcome by 
charging it with carbonic acid gas. 

When an acute attack of gout comes on, it is generally situated, 
as is well known, in the joints of the big toe or other toes, but may 
involve any part of the body, even to the heart and the contents of 
the abdomen. By far the best remedy for the relief of the pain is 
morphine, which should be given hypodermically — some persons say 
as near the spot involved as possible. At the same time the best 
remedy for gout that we have, colchicum, should be freely given 
until the patient shows the full effect of the drug, as evidenced by 
gastro-intestinal discomfort or pain and slight laxity of the bowels. 
The drug should be used in the form of the wine of the root, not that 
of the seeds, in the dose of 20 drops (1.3) at first, and increased by 
1 drop (0.05) every four hours until relief is obtained or symptoms 
of poisoning appear as noted above. In using this drug it is import- 
ant to remember that retrocedent gout is more apt to occur under its 
influence than in an attack where the drug is not used. That is to 
say, the inflammation in the great toe may suddenly disappear, only 
to break forth in a violent and frequently fatal entero-colitis, gas- 
tritis, cerebritis, or heart-failure. Any intestinal irritation or diar- 
rhoea predisposes very commonly to such a complication under the 
use of colchicum. 

The local treatment of gout, when it is active, consists in the 
application of a number of much-vaunted but frequently useless 
remedies. For hospital practice a very useful mixture is made by 
adding 1 part of bicarbonate of sodium to 9 parts of linseed oil, 
and wrapping the joint involved in a piece of lint soaked with this 
concoction. In other cases collodion may be applied in one or two 
good coats, not more, with relief, and in still others oil of pepper- 
mint has been recommended. It is to be remembered, however, that 
the inflamed joints are not to be treated by depletion through leeches 
or bleeding, as by this means they ultimately become worse ; or, in 
other words, the treatment of gouty inflamed joints is not identical 
with that of inflamed joints from other causes. When the pains of 
acute gout are very severe at night, potassium iodide, in the dose of 
15 grains (1.0) at four or five o'clock in the afternoon, will sometimes 
give relief; this drug should always be combined with colchicum if 
the disease is subacute or chronic. 

In chronic gout, except during the acute exacerbations of the dis- 
ease, colchicum is almost useless, but potassium iodide should be 



HEMORRHAGE. 537 

pushed to the point of iodisni if the trouble be painful. Here diet 
comes in for a great part of the treatment, and should consist of 
foods which are not fatty nor rich, but plain and nourishing. Milk 
and eggs, the white meat of chicken, and fruits cooked without sugar 
being added are allowed, tea and coffee being used only in modera- 
tion. If any wine is taken, it must be followed by copious draughts 
of pure water, and this last article should be used ad libitum. On 
the other hand, pastries, and, more than all, sweet wines, are the 
worst things that such a patient can take, and must be absolutely 
prohibited. 

The insomnia of chronic or subacute gout is best put aside by 
potassium bromide and chloral, the former drug being the safest and 
best. 

The local treatment of chronic gout consists in the application of 
flying blisters at a little distance from the suffering joint every few 
days. Where the deposit around the joints is very great and the 
normal movements are impossible, relief is often obtained by the 
application of a solution of citrate or carbonate of lithium, 5 to 10 
grains to the ounce (0.35-0.65 : 32.0) of water, on lint wound around 
the parts. Where the skin is broken and will not heal, this treat- 
ment often permits healing by dissolving the crystals in the wound 
which prevent the approximation of the edges and so cause local irri- 
tation. Iodine ointment or the tincture of iodine is often placed 
around chronic gouty joints with advantageous results. 

A standard remedy in subacute or chronic gout is arsenic, and its 
administration in the form of 3 drops (0.15) of Fowler's solution, 
with either perfectly pure or lithiated water, is always to be resorted 
to. If anaemia is present, arsenic is particularly indicated, and cod- 
liver oil and syrup of the iodide of iron are also of value in this 
state. 

We find, therefore, in conclusion, that the use of large amounts 
of pure water devoid of salts, and the administration of colchicum. 
potassium iodide, and arsenic, are the greater points about which the 
rest of our treatment should centre. In those cases where retrocedent 
gout comes on the heart must be supported by stimulants, particu- 
larly by hypodermic injections of ether until the slower drugs can 
act, by heat over the belly, by the use of opium to allay irritation, 
except when the brain and kidneys are seriously affected, by the use 
of diuretics and alkaline drinks, and finally by counter-irritation in 
the shape of a mustard plaster placed over the abdomen or chest as 
the case may require. 

HEMORRHAGE. 

(Including Menorrhagia, Metrorrhagia. Haemoptysis, Haimatemesis, 
Intestinal Hemorrhage, Hcematuria, and Post-partum Hemorrhage.} 

Under this heading the author will consider all forms of hemor- 
rhage which can be controlled by drugs or measures not directlv sur- 
gical in their scope, with the exception of epistaxis, which has already 
been spoken of. 



538 DISEASES. 

Whenever a hemorrhage can be arrested by the application of a 
ligature or by compression, as in a cut of the finger or some similar 
wound, no styptic should be used. Styptics are employed for the 
double purpose of constringing the tissues and coagulating the blood, 
and, in consequence, form coagula which tend to make a nasty septic 
mass about the wound. In their place the physician should resort to 
a compress soaked in some antiseptic liquid or filled with some disin- 
fectant powder, and if this fails to control the bleeding, then ligation 
of the bleeding vessel becomes necessary. 

Where the bleeding point cannot be reached by direct compression 
or for ligation, the use of packing and of astringents is advisable, 
and drugs which are antihemorrhagic should be used by the mouth. 
As these forms of hemorrhage are generally given separate names, 
they will be so considered. 

In all forms of hemorrhage in which the flow has been sufficiently 
great to endanger the patient's life resort should be had to hypoder- 
moclysis or to transfusion. (See Hypodermoclysis and Transfusion, 
Part III.) 

Menorrhagia is an excessive flow of menstrual blood, either excess- 
ive in quantity during two or three days or prolonging itself over 
an unusual number of days, while metrorrhagia is a state in which 
bleeding takes place from the uterus independent of menstruation 
and at any period of the month, or even after the menopause has 
occurred. 

Menorrhagia, or excessive menstruation, is not to be judged by the 
amount of the flow, but by whether the loss is sufficient to cause 
decrease of health or to indicate disease. In some cases it is a means 
of relieving plethora. 

When the physician decides that something should be done to 
improve the condition of the patient, either in menorrhagia or metror- 
rhagia, it will be necessary for him to find out whether any polypi or 
other form of uterine disease is directly responsible for the trouble, 
and in the mean time to employ drugs known to act favorably upon 
uterine hemorrhage. The most prominent of these drugs are ergot 
and oil of erigeron, the first being the more active and the best rem- 
edy for active bleeding, the second the better for oozing and for cases 
where there is a continual "show." 

The fluid extract of ergot may be given in varying dose, from 10 
to 60 drops (0.65-4.0), according to the necessities of the case, and 
the oil of erigeron in capsules in the dose of from 3 to 5 minims 
(0.15-0.3), or, if capsules cannot be had, the physician must employ 
the oil in an emulsion made by using syrup of acacia or other similar 
substance. 

Where menstruation is irregular and the menorrhagia is almost a 
metrorrhagia, bromide of potassium or sodium in the dose of 10 
grains (0.65) once or twice a day is often very serviceable indeed, and 
the distilled extract of hamamelis in the dose of 1 drachm .(±.0) 
three times a day is almost as useful. Cannabis indica, if an active 
sample is obtainable, is also said to be of service, but the writer has 
never used it to any extent. Oil of cinnamon in the dose of § drachm 



HEMORRHAGE. 539 

(2.0) is very efficacious in the slow oozing of some cases where erige- 
ron cannot be used or obtained. Sometimes, where congestion of 
the pelvic viscera is the cause of the trouble, dry cups over the sacrum 
give relief. 

Haemoptysis, or hemorrhage from the lung, is nearly always due to 
tubercular ulceration of a small or large blood-vessel, and the life of 
the patient depends in reality more upon the rapidity with which a 
clot naturally forms than upon the skill of the physician. Though 
text-books order atomized solutions to be inhaled and other remedies 
to be taken by way of the lung, in most cases these measures will be 
found impracticable, simply because the nervousness of the patient 
and the constant cough will not permit of inhalations to any extent, 
and even if a full breath is taken, it generally increases the bleeding 
and coughing. The only occasions on which inhalations of styptics 
are of service are those in which the hemorrhage is just beginning or 
so slight as to streak the sputum or to be at least thoroughly mixed 
with it. The solutions to be so employed must be used in an atomizer 
w T hich will throw a fine spray — sufficiently fine to enter the smallest 
air-tubes Avith the inspiratory wave of air. A very good fluid is one 
made from Monsel's solution, as follows : 

R. — Liquor, ferri subsulphat gtt. xx to xxx (2.0). 

Aquffidest f$iv (128.0).— M. 

S. — Use in an atomizer every few minutes. 

Or the following : l 

R. — Acid, tannic gr. xx (1.3). 

Glyeerini . . f^ij (8.0). 

Aquas dest q. s. ad f^iij (96.0).— M. 

S. — Use in an atomizer. 

Or, 

R — Aluminis gr. vj (0.4). 

Aqua; dest f^iij (96.0).— M. 

S. — Use in an atomizer. 

Some clinicians advise that the patient should swallow, whether 
the hemorrhage be acute or not, not less than 1 to 1J drachms (4.0- 
6.0) of the fluid extract of ergot, or a solution made by adding 20 
grains of gallic acid to 1 ounce (1.3 : 32.0) of water. Tannic acid 
given by the stomach is not as good as gallic acid, because it must be 
absorbed and changed into gallic acid before it can reach the bleeding 
point through the circulation. On the other hand, the tannic acid, if 
locally used, is the better, for it constringes the tissues and forms a 
clot, whereas gallic acid does not coagulate the blood. There is no 
doubt that of all the internal remedies for hemorrhage from the lungs, 
aconite is the best. Careful studies show that ergot causes primarily 
an increased flow of blood to the lung, although its dominant and final 
action is to cause contraction of the blood-vessels. Hemorrhage from 
the lung is to be regarded as any other hemorrhage. The object of 

1 If the Monsel does not stop the hemorrhage,. the tannic acid will probably fail, 
but, more important still, the two should not be used together, as the tannate of iron 
will be formed, which is as black as ink. 



540 DISEASES. 

the physician is not to stimulate the heart and vasomotor system, 
thereby increasing the leakage from the bleeding vessel, but to lower 
the arterial pressure to as low a point as is safe. The rule to follow 
is best stated as follows : If the patient is seen early in the attack, give 
full doses of aconite to prevent further hemorrhage. If when seen 
so late that he is too much exsanguinated to use sedatives, place his 
head lower than the feet and apply Esmarch bandages to the limbs 
to keep the blood in the vital parts as far as possible. The use of 
stimulants can only increase the hemorrhage by increasing the pump- 
ing power of the heart and by dislodging the clot from the eroded 
blood-vessel. 

To allay nervous excitement many writers advise that a hypodermic 
injection of morphine should be used. The author is convinced that 
this treatment is irrational, for morphine is a circulatory stimulant, 
and by increasing the power of the heart increases the hemorrhage. 
Chloral and the bromides are much better remedies, and should be 
given by the mouth, or, if vomiting is present, they should be given 
by the rectum, dissolved in starch-water. (See Chloral and Bromides.) 

Sometimes the patient can point directly to the spot where the 
hemorrhage exists, and under these circumstances a dry cup or a 
piece of ice placed over this point may prove useful. 

After an attack of haemoptysis there is great danger in many cases 
of a traumatic pneumonia being set up by the presence of the extra v- 
asated blood. This should be combated by the use of a carefully 
regulated diet, and the reduction of any arterial excitement by small 
doses of aconite in persons not tveakened by advanced disease or bleed- 
ing. Complete rest in bed is to be insisted on, and no stimulants 
allowed in food or drink unless the weakness of the patient requires it. 

Hmmatemesis. — This depends either upon some injury to the stom- 
ach or, much more commonly, upon gastric ulcer, cancer, or some other 
severe form of gastric trouble, and is one of the easier of the so-called 
"internal hemorrhages" to treat, because by ordering the patient to 
swallow drugs we can act directly upon the bleeding surface. 1 In 
such a case small pieces of ice should be swallowed frequently, and 
this may be accompanied by 3 drops (0.15) of Monsel's solution in a 
half tumblerful of water every fifteen minutes till four doses are 
taken. Tannic acid may be given instead in the dose of 20 grains 
to a drachm (1.3-4.0), but the two should never be given at once in 
the same case. (See foot-note to p. 539.) Monsel's salt may be given 
in pill in the dose of 2 to 3 grains (0.1-0.15). The acetate of lead 
is also of value in pill form in the dose of 2 to 3 grains (0.1-0.15) 
with morphine or opium. Tincture of the chloride of iron, the sul- 
phate of iron, turpentine, ipecac, ergot, and hamamelis may all be 
used, the last three particularly in slow or passive hemorrhages. 
Sometimes nitrate of silver in the dose of J of a grain (0.016) in 
pill form is of service if the hemorrhage is a slow one. 

1 Ha?matemesis also ensues as a result of swallowing blood which has escaped into 
the mouth or naso-pharynx, and this symptom is sometimes induced by malingerers 
in order to further their ends. These forms of haematemesis should, of course, be sep- 
arated from those dependent upon some lesion in the stomach itself. 



HEMORRHAGE. 541 

Hemorrhage from the bowel is to be treated according to its point 
of origin. If in the small intestine, as from ulceration of Peyer's 
patches or other glands, the medicines must be used by the mouth ; if 
it be from the colon or rectum or from hemorrhoids, medication must 
be by way of the anus. 

Hemorrhage of the first class is best combated by the taking of 
small amounts of ice by the mouth and by the use of Monsel's salt 
(ferri subsulphatis) : 3 grains (0.15) should be given every half-hour 
or oftener, the pill being made hard, enough to reach the intestine 
without being dissolved and decomposed in the stomach. 

Ergot has been largely resorted to, but is of doubtful value, but 
tannic acid may be given with advantage in large amount in solution 
or pill if the Monsel's salt is not obtainable. The other remedies 
which are of service are sulphuric acid in the dose of 5 to 10 drops 
(0.3-0.65) in water in acute or passive bleeding, or turpentine given 
in capsule, or, better still, in emulsion with acacia in the dose of 10 
drops (0.65) every half-hour, particularly when the hemorrhage is not 
active. Acetate of lead and camphor in the following pill may be of 
service in some cases : 

R. — Plumbi acetatis gr. v (0.3). 

Camphorae gr. x (0 65"). — M. 

Ft. in pil. No. v. 
S. — One pill every hour. 

Where the hemorrhage is dependent upon ulceration of the colon 
or rectum injections are to be resorted to. These are both styptic and 
curative, the styptic injections being particularly useful when the 
bleeding is to be stopped at once, the others where it is sought to 
remove the condition producing the trouble. 

To the first class belong alum, sulphate of copper, Monsel's solu- 
tion, sulphate of iron, tannic acid, and .cold water. In the second we 
find nitrate of silver, the sulphates of copper and of iron, and the 
chlorate of potassium. 

The alum solution used should be fairly strong, 10 grains to the 
ounce (0.6'5 : 32.0); the copper, 5 grains to the ounce (0.3 : 32.0); 
the Monsel's salt, 10 grains to the ounce (0.65 : 32.0); or \ to 1 
drachm of Monsel's solution to each 2 ounces (64.0) of water. The 
tannic acid should be used in the strength of 20 grains to the ounce 
(1.3 : 32.0) of water and glycerin. When chlorate of potassium is 
used it should be employed in saturated solution in small injections 
(25 grains to the ounce [1.65 : 32.0]), or weaker if the injection be a 
large one (10 grains to the ounce [0.65 : 32.0]). 

These injections should be carefully given, and the success or 
failure attending the treatment of these states depends as much upon 
the technique of the operation as upon the injection of the medicinal 
substance. It should never be forgotten that an injection designed 
for local medication should be as small in bulk as circumstances will 
permit. Thus, in inflammation of the rectum the amount of the 
injected liquid should not be above 4 ounces (128.0) at the utmost, 
and preferably 2 ounces (64.0) unless the diseased area is high up. 
An enema is given in bulk so as to cause distention and excite the 



542 DISEASES. 

bowel to movement, whereas from a medicinal injection no movement 
is desired. Again, the apparatus for sending in the fluid ought not 
to be a "family" or ordinary syringe, but a fountain syringe, the 
pressure being hydrostatic. This may be dispensed with if the injec- 
tion be small and only intended for the lower part of the rectum, but 
it is indispensable if the injection be intended to reach the upper part 
of the colon. The entrance of the liquid should always be gradual 
and easy. If resistance is met with, the pressure must be overcome, 
not by force, but by waiting a moment until it passes off. When the 
entire colon is to be flooded, at least a gallon of warm liquid may be 
needed. In these cases those drugs which are capable of absorption 
and the production of poisonous symptoms are not to be used except 
in small amounts. (See Enteroclysis. Part III.) 

Where the injection is to reach high up into the bowel the patient 
should be put in the lithotomy position with the buttocks elevated 

Sometimes in dysentery the injection of a pint to a quart of ice- 
cold water has a most favorable effect upon bloody purging. 

Whenever a medicated injection is to be used for the cure of ulcers 
which cause hemorrhage, the entire tract which is to be invaded 
should be washed out with pure water or with a saline or soapy 
liquid, in order to dislodge mucus and faeces, which prevent the drugs 
from acting on the bowel-wall. 

Hoematuria is a condition in which blood appears in the urine, and 
may be divided into two classes — that in Avhich the blood comes from 
the kidney or bladder, and that in which it comes from the urethra. 
In the first class the blood is always well mixed with the urine, 
which is changed in color from its decomposition, and appears either 
through the entire act of urination or just at the end of the act. In 
those instances in which the blood is in the first part of the stream it 
arises in the urethra, is nearly pure, and not well mixed with the urine. 

If the blood is due to the presence of an acute nephritis, the kid- 
neys need treatment, and for directions as to this point the article on 
Acute Bright's Disease should be read ; while, if the hemorrhage is 
due to the presence of a lesion in the bladder, the directions govern- 
ing the use of turpentine, erigeron, or ergot, as given for Menor- 
rhagia and Metrorrhagia, should be followed, or if any morbid growth 
be present it should be removed. Sometimes 10 to 20 grains (0.65- 
1.3) of camphor in divided doses are of service, given in pill form, 
while in others cannabis indica is of value. 

Gallic acid, in 20-grain (1.3) doses, may be used, and is very val- 
uable. If the hemorrhage is alarming, injections of astringent 
washes, such as 2 or 3 grains of alum to the ounce of water, should 
be injected into the bladder. It must be remembered, however, that 
this simply fills the bladder with clots, which are not readily passed 
and are liable to become septic. 

A very useful prescription is — 

R.— Acid, gallic £j (4.0). 

Acid, sulphuric, dil fzij (8.0). 

Aquae . . ^ q. s. ad fgiij (96.0).— M. 

S. — Teaspoonful (4.0) in water every four hours. 



HEMORRHOIDS. 543 

If the hematuria be malarial, quinine may be employed, but in a 
large number of cases it makes the hematuria worse ; and in the 
Southern United States, where severe malarial poisoning is often 
seen, physicians ought rarely, if ever, to use the drug for malarial 
hematuria. The value of quinine consists in its ability to prevent 
future attacks rather than to relieve the result of the attack — namely, 
the hematuria. Hyposulphite of sodium is a most useful remedy in 
the dose of 5 to 15 grains (0.3-1.0) every five hours. 

Post-partum hemorrhage is to be controlled by the use of friction 
and kneading or grasping the dilated uterus through the relaxed ab- 
dominal wall; by the use of drachm doses of the fluid extract of ergot 
or a wineglassful of the wine of ergot ; and by the irritation of the 
uterine wall by passing the hand, which must be absolutely aseptic, 
up through the vagina into the uterine cavity. Sometimes ice may be 
passed up the vagina and into the uterine cavity with success in stop- 
ping the bleeding, and even vinegar and lemon-juice may be tried if 
the case is a desperate one. In other cases injections of water as hot 
as can be borne may be resorted to. 



HEMORRHOIDS. 

Hemorrhoids are vascular dilatations of capillaries, arteries, or ven- 
ules situated outside or inside of the sphincter am, or are composed, 
in the case of Avhat are called external piles, of tags of skin which 
are more or less vascular and become troublesome when inflamed. 

The internal pile, if large, is apt to prolapse and to become 
strangulated by the sphincter muscle. It is covered by mucous 
membrane, and is sometimes very small or like a mulberry in shape, 
consisting of a tuft of capillaries, a loop of an arteriole, or of a venule. 
The capillary or arterial type is apt to be bright red, and to bleed 
profusely when touched or when scraped by hard faeces. The venous 
tuft also bleeds, but not so freely, and the blood is not so bright in 
color. In cases in which the hemorrhoids " come down " — that is, 
pass out through the anus, so being in danger of becoming stran- 
gulated — the protruding mass should be washed with cold water, 
thereby at once cleansing the mass and reducing its congestion, 
and then gently pushed back with the fingers, which should be well 
oiled. Care should be taken that an external hemorrhoid is not 
mistaken for an internal pile, since if an external growth is pushed 
through the sphincter, it also becomes strangulated. 

The treatment of internal hemorrhoids is to a great extent iden- 
tical with that of the external variety. A suppository may be used, 
made up as follows, if there is a tendency to slight hemorrhage : 

R. — Acid, gallic . gr. xx (1.3). 

Extract, opii gr. j (0.05). 

Extract, belladonna? gr. ij (0.1). 

01. theobromse q. s. — M. 

Ft. in suppos. No. x. 
S. — Use one every night, or distilled witch-hazel extract may be injected into the 
rectum. 



544 DISEASES. 

If the hemorrhage is profuse, the physician should use a speculum, 
find the bleeding point, and touch it with strong nitric acid, followed 
by the suppository named above. If this is done, the bowels should 
be confined for some days, until the spot under the slough made 
by the acid can heal. If the prolapsed hemorrhoid is inflamed and 
difficult of reduction, the following ointment of Matthews may be 
ordered : 

R. — Cocain. hydrochlor gr. xij (0.8). 

Iodoformi £j (4.0). 

Extract, opii gr. xxx (2.0). 

Petrolati |j (32.0).— M. 

S. — Use as a salve. 

If the pile still refuses to be reduced, place the patient in bed and 
apply hot poultices, and if this fails operation is demanded. 

The treatment of external piles themselves consists in the mainte- 
nance of the most rigid cleanliness. Immediately after each move- 
ment the parts should be thoroughly washed by means of a sponge 
dipped in cold water, or, better still, by the use of the bidet or nozzle 
attached to a fountain syringe or to the general Avater-supply. After 
they are thoroughly cleansed, it is well to bathe them with distilled 
extract of hamamelis. Often it is well to precede the regular morn- 
ing evacuation by a cold rectal injection of pure water to soften the 
feces, but more important still to decrease congestion. If the inflam- 
mation of the external piles is very acute and profound, the patient 
should be placed in bed and the cold injections frequently repeated 
or hot poultices applied to the anus. After the acute stage is passed 
a lotion of lead-water and laudanum (laudanum f^ss to dilute lead- 
water f^ij) may be used. 

The injection of carbolic acid into hemorrhoids is a dangerous 
practice, but if employed only 1 drop is to be used. In addition to 
these applications there are important general rules to be observed. 

The patient's habits should be so arranged that his daily act of 
defecation is at night before going to bed, rather than in the morn- 
ing, as under these circumstances the rest in bed relieves congestion 
and soreness, which the maintenance of the erect posture might make 
worse. Plethoric persons should not use upholstered chairs for office 
or lounging purposes, as the heat of the body relaxes the rectal tis- 
sues. A cane-seated chair is best, or an air-cushion with a hollow 
centre. The liver plays a most important part in relation to hemor- 
rhoids, and, if it is congested, congestion of the hemorrhoidal veins 
is very apt to ensue. The connection between the liver and the 
hemorrhoidal plexus is most intimate, since the plexus is formed by 
the superior hemorrhoidal veins, which are branches of the inferior 
mesenteric, and the middle and inferior hemorrhoidal veins, which 
terminate in the internal iliac. The portal venous system is com- 
posed in part of the inferior mesenteric vein, and any obstruction to 
venous flow in the liver at once results in engorgement of the 
hemorrhoidal plexus. 

(For the surgical treatment of piles reference must be made to 
surgical works.) 



HEADACHE. 545 



HEADACHE. 

(For Neuralgic Headaches, see Neuralgia ; for Bilious Headache, 

see Biliousness.) 

Probably no single source of pain compares in its frequency to 
headache, chiefly because it is essentially a symptom of many dis- 
eased processes or functional disturbances, and nothing more. It 
may arise from eye-strain, from brain disease, from anaemia, from 
uraemia, from plethora, from nervous breakdown, and from a multi- 
tude of causes which, if they were all recounted, would cover many 
pages of this book. The only forms of headache which will be con- 
sidered here are those due to congestion or which arise from fatigue. 

Congestive headaches, dependent upon an engorgement of the cere- 
bral vessels with blood, are to be treated in a number of ways, and if 
any direct cause of congestion can be discovered, this must, of course, 
be removed. So far as the direct application of drugs is concerned, 
Ave find two methods of promoting a cure. The first consists in the 
use of ergot, Avhich will cause contraction of the dilated vessels ; the 
second, in the employment of vascular sedatives, which will produce 
arterial depression and so remove congestion. Sometimes one of 
these methods will succeed where the other fails, and it is almost 
impossible to tell beforehand which case should have one drug and 
which another. It is to be remembered that when the congestion is 
due to vascular relaxation and weakness the vascular sedatives are 
contraindicated. 

The use of a hot mustard foot-bath is of great value, and a mus- 
tard plaster or cup applied to the nape of the neck is often of service 
in congestive headaches, while in severe cases an ice-bag applied to 
the head or leeching behind the ears or on the temples may be re- 
sorted to. Bleeding often gives relief at once in severe congestive 
headache. 

Where headache depends upon fatigue, either general or local, 
stimulating treatment is necessary. If eye-strain be the cause, full 
doses of strychnine or nux vomica are of service. These cannot be 
used if there is much retinal irritability. In many instances a com- 
bination of caffeine, bromide of potassium, and antipyrine is very suc- 
cessful, as follows : 

R. — Caffeinse citratis gr. xl (2.65). 

Potassii bromidi ^iv (16.0). 

Antipyrini gij (8.0).— M. 

Ft. in chart. No. xx. 
S. — One powder in water as needed. 

Sometimes the caifeine makes the headache more acute, and if this 
occurs only the antipyrine and bromide can be used. 
Another useful prescription is — 

R. — Extract, guarana? gr. x vel xx (0.65-1.3). 

Ext. apii graved gr. x (0.65). — M. 

Ft. in capsul., vel chart., vel pil. No. x. 
S. — One every half hour till relieved or three are taken. 
35 



546 DISEASES. 

Sleep is generally a more useful prescription than any drug, and 
if city life creates so much mental anxiety during the day as to be 
wearing upon the nervous system or make the patient wakeful at 
night, business must be put aside and health and recreation sought 
at a watering-place. Horseback exercise is very useful indeed, and 
should be resorted to by all who can afford it if they are sufferers 
from nervous headaches. 

A form of headache which is often very severe, sometimes fleeting, 
sometimes persistent, is that due to gout, and it is to be treated by 
means quite distinct from those named so far. Some practitioners of 
wide experience employ salicylic acid in doses of from 5 to 15 grains 
(0.3-1.0), while others rely on the iodide or acetate of potassium. 
In cases where aneeruia is present Peabody uses the following pre- 
scription, which is compatible, whereas most of the preparations of 
iron and salicylic acid are incompatible : 

R. — Acid, salicylic gr. xx (1.3). 

Ferri pyrophosphat gr. v (0.3). 

Sodii phosphatis gr. j (0.05). 

Aquae dest f£ss (16.0).— M. 

S. — This is to betaken every three hours. 

Cohen has used the following, which is more pleasant to the taste : 

R — Sodii salicylatis ^iv (16.0;. 

Glycerini f^ij (64.0). 

01.' gaultheria? ir\,xx (1.3). 

Tr. ferri chloridi f^iv (16.0). 

Acid, citrici gr. x (0.65). 

Liq. ammonii citratis, B. P. 1 . q. s. ad fgiv (128.0).— M. 
S. — Dessertspoonful (8.0) in water twice, thrice, or four times a day. 

Other cases of a gouty headache require colchicum, particularly 
if the gout be widely distributed in its manifestations, and to these 
Hamilton gives — 



R. — Vini colchici seminis f^ss (16.0). 

Potass ii acetatis ^ 

Potassii iodidi V aa f^v (20.0). 

Tr. cimicifugae racemosgej 

Aqua? q. s. ad ffiv (128.0).— M. 

S. — Teaspoonful (4.0) every four hours. 



HEART DISEASE. 

(For Treatment of Angina Pectoris see p. 427.) 

The writer classifies all forms of heart disease under this heading 
advisedly. In valvular disease the profession are beginning to under- 
stand more and more that the mere destruction or laming of this valve 

1 Liquor ammonii citratis, B. P., is made by adding 5 fluidounces (imperial mens.) 
of strong solution of citrate of ammonium to 15 fluidounces (imperial meas.") of dis- 
tilled water The stronger solution of citrate of ammonium is made by taking 12 
ounces (avoirdupois) of citric acid, strong solution of ammonia 11 fluidounces, and 
adding enough distilled water to make 24 fluidounces (imperial rneas.1. 



HEART DISEASE. 547 

or that has little to do with the treatment, although the ultimate 
result of the case is somewhat dependent upon these conditions. It 
matters not whether the leak in a valve be minute or huge, provided 
the heart can still do its work ; the condition of the cardiac muscle 
is the important factor to be considered. If an irreparable leak 
exists in a pump, the question is not, Can we cure that leak ? but 
rather whether we can work the pump with enough force and rapid- 
ity to obtain all the water needed for the maintenance of life. Some 
physicians use heart tonics, such as digitalis, whenever they find a 
valve diseased, as if to mend the broken valve. Nothing can be more 
erroneous, for a valve once injured is never regenerated. 

It should be an invariable rule with every physician in examining 
a patient with heart disease to determine whether or not the tissues 
of the body receive their normal blood-supply. If they do not, even 
though the leak is so small as to escape notice, digitalis or other 
tonics are to be used ; but even if the murmur heard on auscultation 
is as loud as that of a machine-shop and the tissues are not starved, 
no remedy is needed. 

Another very important point in regard to the treatment of cardiac 
disease in children is the remembrance that the stunting of the body 
and the slowness of growth are not merely the result of heart trouble, 
whereby the tissues do not increase in size from lack of nourishment, 
but occurs for a special purpose. Supposing that a child of eight or 
nine years has scarlet fever or rheumatism, which leaves the cardiac 
valves impaired in function, for a few days, or hours at least, the 
question must arise in the heart: "Can I fill all the blood-vessels 
properly ?" If the heart can supply the vessels, the child lives, but is 
stunted, because Nature is wise enough to understand that the strug- 
gling heart has all it can do to supply even a stunted frame, and 
realizes that a rapidly increasing area of blood-vessel surface in a 
growing child would exhaust the cardiac muscle. 

The physician should not endeavor to make such a child grow by 
gymnastics or tonics, but should direct his attention to the care of the 
general health, and particularly that of the heart, for as soon as this 
organ is strong enough to permit of growth, growth will take place. 

Having made these preliminary remarks, let us turn to the direct 
application of drugs to heart disease, the chief drug in the list being, 
of course, digitalis. 

The value of digitalis may be said to rest upon a number of 
influences possessed by it. In the first place, evidence is constantly 
accumulating to show that digitalis increases the nutrition of the 
heart-muscle by the stimulating influence which it exerts over the 
pneumogastric nerve, this nerve having been partly proved to be a 
trophic nerve of the heart. Aside from any such nervous influence, 
the heart-muscle receives a greater blood-supply under the use of digi- 
talis, since both diastole and systole are influenced by the drug, the 
systole being more complete and the diastole being prolonged and 
more extensive. 

Two theories concerning the nutrition of the heart-muscle through 
its blood-supply have been promulgated. One is, that the coronary 



548 DISEASES. 

arteries are filled with arterial blood as the heart drives its contents out 
of the left ventricle, or, in other words, during systole. The other 
hypothesis rests upon the belief that the contracting muscle prevents 
a free circulation of blood through the cardiac blood-vessels, and that 
the blood is driven into the coronary arteries during diastole by the 
pressure in the aorta, the aortic valve being closed. In the belief of 
the author both of these theories are partly true. That is to say, the 
coronary arteries are filled during ventricular systole, according to the 
first theory, but the complete passage of the blood through the smaller 
vessels of the cardiac muscle only takes place as relaxation or diastole 
occurs. The ground for this belief consists in the observation that a 
muscle when firmly contracted always presses upon its supplying blood- 
vessels, and particularly interferes with capillary flow. The heart of 
one of the lower animals, if carefully watched after the chest-wall is 
removed, will always be found to become paler during systole and 
redder during diastole, and if wounded will bleed more freely during 
the relaxing period than during the contraction of its fibres. As the 
blood everywhere in the body nourishes the tissues, not when in the 
arteries, but while passing through the capillaries, it would seem self- 
evident that, while the coronary arteries are filled by the systole or 
contraction of the heart, the nutritive changes and perfect capillary 
circulation go on during diastole. If these things are true, the increase 
in cardiac nutrition and growth under the action of digitalis is only 
what one would expect, for we have learned when studying this drug 
that it prolongs diastole and increases the force and volume of the 
systolic wave of blood. In other words, digitalis fills the coronary 
arteries almost to bursting, and so, when diastole occurs, not only 
floods the cardiac capillaries with blood, but prolongs the period during 
which the interchange between the blood-stream and tissues takes place. 

There is still another Avay in w T hich digitalis does good in cardiac 
disease by reason of its peculiar powers. Normally, the heart beats 
fast or slow according to the demands for blood made upon it by the 
system, and its action is varied by the calls which it receives from the 
tissues. In heart disease, with failure of compensation owing to the 
leaky valves, the tissues are starved, and continually send messages 
for more nourishment to the cardiac muscle, which finally becomes 
exhausted by its endeavors to supply their wants, and beats now fast 
and now slow, uncertain what to do. If digitalis is given, the vagi 
render the cardiac action regular and effective, acting as regulators 
and directors of its energies, thereby supplying the tissues and using 
the remaining power of the heart to the greatest advantage, in addi- 
tion to improving its blood-supply by the methods already described. 
The starving tissues of the body having been satisfied, as Wood has 
eloquently expressed it, " the angry messengers from the periphery 
cease their callings, and the heart is at peace and in comfort." 

From what has been said it becomes evident that this drug, digi- 
talis, does good whenever the heart is weak or unable to supply the 
body with blood, and we find for this reason that cardiac dilatation, 
simple cardiac failure, or heart failure dependent upon the presence 
of poisons all indicate its use. 



HEART DISEASE. 549 

The mechanism of the action of digitalis in the different cardiac 
lesions still remains to be described. 

Taking up the most common condition, that of mitral regurgitation, 
we find that in this disease the blood passes, in its normal flow, from 
the auricle into the ventricle, and, when the ventricle is filled, that 
the cardiac muscle contracts on all sides equally. Normally, the 
mitral valves close the auriculo-ventricular opening and prevent any 
of the blood from regurgitating back into the auricle, and the greater 
the pressure the tighter they become. Abnormally, the blood is still 
pressed upon on all sides as before, and, trying to escape, as do all 
liquids, from pressure, finds that, owing to disease of these valves, it 
can, in part at least, slip back into the auricle from w T hich it came, 
rather than pass out into the high pressure of the arterial system. 
The ventricle, therefore, propels blood in two directions — in the wrong 
way and in the right way. If the leak is large enough to carry off 
more blood than the aorta, then death occurs. Digitalis under these 
circumstances does good, because, by increasing the force of the ven- 
tricle, it increases the friction at both the mitral leak and the aortic 
opening ; but, as the aortic opening is a large one and the mitral leak 
a small one, the greater quantity of blood passes out into the circula- 
tion. The same fact arises for consideration as before — namely, that 
it is not the amount of leak, but the amount of supply to take its 
place, which is the vital question in the case. Sometimes relief does 
not occur, and the patient is made worse by digitalis, because the leak 
is increased as much as the normal flow. 

In mitral obstruction the difficulty is that the blood cannot enter 
the ventricle with sufficient rapidity, and this part of the heart con- 
tracts before it is well filled. By the prolongation of diastole the 
blood is given sufficient time to enter and the ventricle is filled, send- 
ing out into the system a large wave of blood when it contracts. 
Further than this, the stimulation of the right ventricle by the 
digitalis enables this part of the heart to overcome the tendency to 
congestion w r hich arises through the obstruction on the left side of 
the heart. 

In aortic stenosis there is obstruction to the normal flow of blood 
out of the heart, and the digitalis is needed to increase the ventric- 
ular force, so that it may overcome the difficulty. 

In aortic regurgitation digitalis, by its stimulation of the heart, 
may cause a sufficient output of force to clear itself of the regurgi- 
tant floAv, but in many cases the drug fails, because the prolongation 
of diastole gives so much more time for the blood to flow backward 
into the dilating ventricle. The cardiac remedies to be used in such 
cases are strophanthus, in the form of the tincture, dose 3 to 5 drops 
(0.15-0.3), adonidin, dose I to J grain (0.013-0.025), and sparteine 
J grain (0.025). These remedies may also be used in the other forms 
of cardiac disease where digitalis fails. It is important to remember, 
however, that some cases of aortic regurgitation do improve, at least 
temporarily, under digitalis. 

In cardiac dropsy digitalis and the other heart stimulants do good 
by raising blood-pressure and pulse-force, and in some instances by 



550 DISEASES. 

stimulating the kidneys to increased efforts at elimination. (See 
Dropsy.) 

In sudden cardiac failure from weakness or poisons the use of 
ether and ammonia is to be resorted to at once, and these are to be 
followed by alcohol and digitalis if necessary. The ammonia is a 
direct heart-stimulant, as are also the alcohol and ether. 

In cardiac palpitation dependent upon indigestion this condition 
must be relieved by appropriate digestive remedies ; but in that form 
of palpitation due to over-exertion or heart-strain digitalis is useful. 
Iron is to be used if the irritability is due to anaemia. Tea, coffee, 
tobacco, and excessive venery are to be forbidden. Sometimes nux 
vomica does good by stimulating the heart and nervous system, and 
belladonna seems of great value where arhythmia is present. Ringer 
recommends the use of veratrine ointment over the praecordium in 
many of these cases. 

Cardiac hypertrophy is rarely seen without some other lesion 
accompanying it, but it may occur from prolonged and excessive exer- 
cise or other cause. It is to be treated by perfect rest and avoidance 
of exercise, and by the use of moderate amounts of food of a non- 
stimulating character. Wines and coffee should be forbidden, and 
small amounts of veratrine ointment or a belladonna plaster may be 
placed over the praecordium if the action of the heart is very exces- 
sive. Both palpitation of the heart and cardiac hypertrophy are 
very favorably influenced in many cases by aconite or veratrum viride. 

Those who are in the habit of seeing young men will constantly 
have their attention called to a condition of shortness of breath on 
exertion, palpitation, or violent pulsation of the heart, and in some 
instances the development of severe symptoms which, at first glance, 
may seem to be those of true angina pectoris. In many of these 
youths there will be a history of the excessive use of tobacco, or that 
they have left college, where they have been indulging in severe ath- 
letic exercise, such as running or bicycle-racing, and have gone into 
business, where they lead a most sedentary life. In these cases the 
condition which exists is comparable to the condition which exists in 
a steamer whose engines are too strong for her hull. The heart, which 
has heretofore been supplying the body of an athlete with blood, now 
finds itself too strong for the sedentary individual. There is prob- 
ably no remedy which will give such good results under these circum- 
stances as aconite, given in the dose of 1 minim (0.05) of the fluid extract 
or 2 to 3 minims (0.1-0.15) of the tincture three times a day, partic- 
ularly if at the same time a good belladonna plaster about four inches 
square is applied over the praecordium. Many cases of tobacco heart, 
in which there is arhythmia, with an excessive cardiac impulse over 
the praecordium, with palpitation on exertion, will be benefited by 
aconite used in this way ; but where the heart seems much depressed, 
so that the apex-beat is feeble and the first and second sounds are not 
clearly heard, aconite will seldom, if ever, do good. 

In that form of functional cardiac disorder due to indigestion aco- 
nite is not capable of producing the results which are obtained in the 
cases which we have just mentioned. It may, however, be used as a 



HEART DISEASE. 551 

remedy of value at the same time that the physician is directing his 
attention to the cause of the trouble — namely, the gastro-intestinal 
disorder, with the treatment of which this article has nothing to do. 
Here, again, a condition of cardiac feebleness contraindicates the 
employment of this drug. 

Passing to the employment of aconite in cases of true cardiac dis- 
ease, Ave find that a careful study of a certain number of cases will 
soon show the physician that this drug is capable of doing more good 
in some instances than is digitalis. 

The history of the following case illustrates this point : A man, 
aged nineteen, was brought to the hospital suffering from aortic 
obstruction, and as a result of this was attacked with dyspnoea on the 
slightest exertion, marked cardiac arhythmia, with palpitation, some 
giddiness, and a tendency to nose-bleed. He stated that in the early 
part of the year, and for several years preceding it, he had been a 
deck-hand on a coastwise vessel, where he performed hard manual 
labor, notwithstanding the condition of cardiac disease which was 
present, and of which he knew nothing. During this time he suf- 
fered from no symptoms indicating cardiac disorder. In other words, 
compensatory hypertrophy was complete. Because of the exposure 
incident to the work he was forced, under the advice of a physician, 
to earn his living on shore. He was unsuccessful in trying to obtain 
employment, and a prolonged period of muscular inactivity followed. 
As a consequence of this the cardiac hypertrophy, which had hitherto 
been compensatory, was now excessive, and he suffered from marked 
cardiac palpitation, with disordered circulation in the extremities, 
and from a considerable amount of cough. Very early in the study 
of the case it was recognized that these disorders were due to the 
excess of cardiac hypertrophy, and not to failure in compensation, 
and, as a consequence, that a cardiac depressant was indicated rather 
than a cardiac stimulant in the shape of digitalis. 

He was given from 1 to 2 minims (0.05-0.1) of the fluid extract of 
aconite three times a day, and during the continuance of this treatment 
was purposely confined to his bed. At the end of the week so much 
improvement had taken place in his condition that he was allowed to 
rise and go about the ward as he wished, and after four weeks, the 
medicine being continued during this period, he was so well that he 
was discharged from the hospital, with no other evidence of cardiac 
disorder than physical examination would show. 

Many instances of the value of aconite in both functional and 
organic cardiac disease could be cited, but these are probably suffici- 
ent. Where the aconite alone fails to give relief, rest in bed is essen- 
tial, in order that the heart may not be excited to great activity by 
exercise of the limbs, and also because the recumbent posture allows 
the physician to use larger doses of the drug. 

An exceedingly useful treatment of excessive cardiac Inqiertrophy 
is rest in bed without medication. The results in some cases are 
extraordinary, whether the hypertrophy be due to valvular disease or 
other cause. 

Fatty heart occurs in two forms — that in Avhich true fatty degen- 



552 DISEASES. 

eration has taken place in the muscular fibre, and that in which there 
is a deposit of fat between the fibres. Nothing of any importance 
can be done for the first state, but much for the second. The patient 
suffering from this latter form of heart trouble is nearly always 
obese, and should suffer abstinence from fats and rich foods, from all 
sweet wines or malt liquors, from sugars and milk, and, at the same 
time, take exercise. At first this treatment may cause dyspnoea, but 
by gradually increasing the severity of the exercise great feats can 
generally be effected in the end, with marked improvement in the 
cardiac action. (See Obesity.) 



HEPATITIS. 

(Acute and Chronic Hepatitis and Hepatic Abscess.) 

Inflammation of the liver may be produced by many causes, such 
as injuries, cold, exposure to high heat (as in the tropics), syphilis, 
and the presence of any infectious disease or of parasites. It may 
also arise from alcoholism. The acute form is rarely directly pro- 
duced by syphilis unless by the presence of some other form of the 
disease, such as gumma or the absorption of septic materials into the 
circulation from wounds or sores. The same may be said of the hepa- 
titis of hot climates, which is generally subacute or chronic. The 
pain, swelling, and general symptoms of the acute form of inflamma- 
tion of the liver are described thoroughly in the text-books on the 
practice of medicine. The measures commonly adopted for the relief 
of the symptoms and the disease itself are of two kinds : the first, 
medicinal : the second, dietetic. 

The patient, if the attack be acute or severe, will commonly be 
found in bed, owing to the pain and fever, but if not he must be 
placed in bed and kept in a recumbent posture. Over the surface 
of the right hypochondrium should be placed two cantharidal blisters 
of the diameter of from one to three inches, or, if this is not possible, 
a large mustard plaster is to be used. Sometimes hot cloths applied 
over this area not only give relief, but also aid in the formation of the 
blister. At the same time, if the bowels are greatly confined, a saline 
purgative may be given, and be preceded by 1 grain (0,05) of calomel 
given in fractional doses, In regard to internal medication, the phy- 
sician should recollect that hepatitis is. like every inflammation, a local 
hyperemia or vascular engorgement, and, in consequence, that aconite 
in full doses is useful. Veratrum viride may be used, but as it may 
produce vomiting and disturb the liver, it should rarely be employed. 
The kidneys may be kept active by spirit of nitrous ether and citrate 
of potassium, or by any one of the diuretic waters, such as Vichy, in 
moderate quantities. If the inflammation is not aborted by this 
treatment, it will go on to hepatic abscess. 1 If hepatic abscess 
develops, the best thing to be done is to aspirate and draw off the pus. 

1 Just here it may be well to recall that many cases of hepatic abscess are now 
known to be due to dysentery, and that the diseased state of the lower bowel may 
infect the liver. 



HICCOUGH. 553 

Very frequently the inflamed organ will form so strong an attachment 
with the peritoneal coat of the abdominal cavity that a bistoury may 
be used to free the pus if an aspirator is not at hand. After pus is 
once formed any constitutional evidence of its presence, as by night- 
sweats, hectic, or rigors, is a sign for immediate interference with the 
purulent collection by the physician. If dysentery exists, it must be 
cured as rapidly as possible by the measures generally employed for 
this purpose. (See Dysentery.) 

The diets during the early and later stages of acute hepatitis are 
almost identical, and may be resorted to in the subacute and even in 
the chronic forms of the disease. It should consist of koumyss to a 
great extent, or matzoon may be employed, but "strong foods," such 
as meats of all kinds, particularly beef, pork, and mutton, are to be 
sedulously avoided. All spices in the food must be forbidden, and 
alcohol utterly tabooed. If koumyss cannot be had, the patient may 
be fed on peptonized milk or pancreatized oysters. (See Part III.) 
After the abscess develops the same recommendations are to be fol- 
lowed, and the diet is to be as supportive as possible, small doses of 
quinine and iron being used. 

In the treatment of the subacute or chronic hepatitis of hot 
climates no remedy compares to freshly-prepared strong nitromuriatic 
acid, used both externally and internally. The acid should be a deep 
lemon color, and be mixed with water only when about to be taken, 
in the dose of 3 to 4 drops (0.15-0.2) three times a day. This rem- 
edy is contraindicated in acute hepatitis, because it acts by stimulating 
the organ, and would only increase the severity of the acute form of the 
disease if administered at this time. Externally, it is to be used by 
mixing it with water and applying it by means of a flannel wrung out in 
the mixture, or by placing it on spongiopiline in the proportion of from 
1 to 3 fluidrachms to the pint (4.0-12.0 : 500 cc.) of warm water and 
applying it over the liver. If 3 fluidrachms (12.0) irritate the skin 
too greatly, the smaller quantity should be employed. This applica- 
tion causes a tingling of the skin and a localized sweat. 

The hepatitis due to syphilis generally shows itself as a cirrhosis, 
and is to be treated by antisyphilitic measures. (See Syphilis.) 

If ascites develops from cirrhosis, the liquid is to be withdrawn, 
and frequent aspirations, as often as the liquid returns, have been 
known to result in apparent final cure or arrest of the disease. In 
all forms of chronic hepatitis iodide of potassium is a useful remedy 
in the dose of from 5 to 10 grains (0.3-0.65) three times a day, or 
larger amounts may be used if the case be due to syphilis. 



HICCOUGH. 

This is an affection arising from many causes, depending upon irri- 
tability of the nerves supplying the diaphragm as a result of gastric 
irritation, nervousness, uraemia, and as a complication of several 
exhausting diseases, such, for example, as typhoid fever. 

The mechanism of its production rests upon the sudden contrac- 



554 DISEASES. 

tion or descent of the diaphragm, whereby a vacuum is formed in the 
chest into which the outside air attempts to rush, but is prevented 
from doing so by a sudden closure of the glottis, the peculiar sound 
of the hiccough being thus developed. Generally the symptom stops 
of itself, but it may become excessive. 

The remedies to be employed are used according to the cause of 
the disorder. If there be gastric or intestinal irritation, the irritating 
matter must be removed by emetics or purges, and nervous and local 
sedatives used. A few drops of spirit of chloroform do good in many 
cases, and a little tincture of capsicum may be employed in other 
instances, say 2 or 3 drops (0.1-0.15) well diluted. Children should 
only have J to 1 drop (0.025-0.05) of the tincture, well diluted. 
Spirit of camphor, or the tincture of valerian, in the dose of 1 drachm 
(4.0), maybe serviceable, and Hoffmann's anodyne is peculiarly appro- 
priate in the dose of 1 drachm (4.0) in starch-water. In the hiccough 
of typhoid fever nothing compares to musk, 10 grains (0.65) by the 
rectum, and, if this cannot be used, oil of amber may be given by 
the mouth in the dose of 5 to 10 drops (0.3-0.65) in capsule or emul- 
sion, and followed by a drink of milk to prevent irritation of the 
stomach. Nitrite of amyl may also be inhaled. 

Where external remedies are resorted to, ether thrown in a line 
spray on the epigastrium may stop an attack. 

In cases where the affection comes on after meals and is due to 
indigestion, a course of tonic treatment will often give relief. Thus 
mix vomica in pill or tincture, accompanied by some dilute mineral 
acid, such as hydrochloric or nitric, may be employed, or 

R.—Sodii bicarb 3J # (4.0). 

Tinct. nucis vom f^j (4.0). 

Tinct. eardamomi q. s. ad f|iij (96.0). — M. 

S. — Teaspoonful (4.0) before each meal. 

If the symptom be due to uraemia, a hypodermic injection of hydro- 
chlorate of pilocarpine will be found of service, unless it is contra- 
indicated by advanced depression and systemic weakness. 



INCONTINENCE OF URINE. 

Incontinence of urine may be classified either according to its forms 
or the methods of its treatment. 

Four varieties may be recognized as occurring separately, although 
all of them may occur in one case. There are cases where the bladder 
fails to hold the urine day or night, those in which the incontinence 
is only nocturnal, and those in which it occurs only upon some ner- 
vous start or in which the sphincter becomes relaxed from general 
atony. The first of these occur in children, the last in adult females. 
A fourth form of incontinence depends upon paralysis arising from 
centric nervous disorder or from paralysis due to retention and conse- 
quent paralytic distention. 

Taking up the consideration of the first forms — namely, those 
occurring in children, in which the trouble is generally nocturnal — 



INCONTINENCE OF URINE. 555 

the complete history and the present condition of the case must be 
discovered. Many of the most obstinate cases will yield when the 
urine is made clear and mild by the use of alkalies, and others will 
recover upon the removal of worms from the vagina, which have 
crawled there from the rectum, or upon circumcision of a redundant 
prepuce, particularly if this be tight and smegma and urine be found 
back of it in large or small quantity. The cause of the incontinence 
in both these conditions is reflex irritation exercised by the urine on 
the bladder-walls, or by irritation at the end of the penis or in the 
vagina, and the reason that alkalies do good is that they render the 
urine, which is concentrated and irritating, dilute, alkaline, and mild. 
Belladonna in these cases is rarely, if ever, curative, and is at most 
only palliative, the condition returning as soon as the passing off of 
the effects of the drug permits the irritation to be felt by the nerves 
of the bladder. After alkaline diuretics have been used belladonna 
is, however, very valuable. 

Where the urine is concentrated and dark in color the following 
prescription is always useful : 

R. — Potassii citratis t ^ss (16.0). 

Spt. setheris nitrosi f^vj (24.0). 

Aqua? q. s. ad f^j (32.0).— M. 

S. — Dessertspoonful (8.0) every four hours in equal quantity of water. 

As the urine becomes clear after several days a few drops of tinc- 
ture of belladonna may be added to the mixture ; but if a little is not 
sufficient, it must not be increased, as belladonna will not cure the 
condition, and may make the urine concentrated — a condition directly 
opposed to that which is wanted. 

Sometimes these cases are dependent not so much upon vesical 
irritability as upon weakness of the spinal centres governing the 
bladder. If this be the case, the remedies used should be directed to 
the improvement of these parts, and the following pill should be 
administered or the succeeding solution : 

R.— Acid, arsenosi gr f(0.02). 

Extract, nucis vomicae gr. ij (0.1). — M. 

Ft. in pil. No. xx. 
S. — One three times daily after meals for a child of eight or ten years. 

Or, 

R.— Liquor potassii arsenitis gtt. xxiv (1.6). 

Tinct. nucis vomicae gtt. xvj (1.0). 

Aqua? q. s. ad f^iij (96.0). — M. 

S.— Teaspoonful (4.0) three times daily after meals for a child of eight or ten years. 

This mixture is so bitter as to be exceedingly disagreeable, and 
Fowler's solution may often be used alone in the dose of J to 1 drop 
(0.025-0.05). and at the same time strychnine in gelatin- or sugar- 
coated pill or granule. 

It must be remembered that this last treatment is only to be 
employed in chronic cases devoid of all irritation and dependent upon 
atony. It will not do good if the urine is not previously made clear. 

Nothing can be more unfortunate in the treatment of these cases 



556 DISEASES. 

than punishment by severe scolding and whippings, as it never does 
good, and, the fault being beyond the child's control, the unjust pun- 
ishment makes him sullen, or through nervousness, augmented by 
such treatment, his trouble becomes worse. In some cases it may 
be necessary, in order to cure the habit, to let the child drink diu- 
retic waters for years, and the patient should always be taken up 
from bed when the parents retire for the night and made to evacuate 
the bladder. 

In the incontinence of adult females or males on laughing or sud- 
den movement nothing compares, from a curative point of view, to 
drop doses of tincture of cantharides three times a day, -the urine 
being kept flowing freely from the kidneys by means of alkaline 
diuretics. 

The treatment of the fourth form of incontinence of urine comes 
into the province of surgery. The bladder must be relieved by the 
catheter if the trouble be from retention. If the disorder is due to 
paralysis, nothing can be done except to carry out those general 
measures valuable in such cases — to maintain the urine in as normal 
a state as possible, to frequently catheterize with an aseptic catheter, 
and to wash out the bladder every few days or hours, as the case may 
be, with some weak antiseptic fluid, such as the 1 : 10,000 solution 
of bichloride of mercury, or 1 : 100 of carbolic acid, or 1 : 100 of 
boric acid. 



INDIGESTION (GASTRIC AND INTESTINAL). 

Under the heading " Biliousness " the writer has already described 
many of the conditions arising out of indigestion, and, this being the 
case, the consideration of that state known as dyspepsia or indigestion 
will only receive attention at this point in so far as its cure is con- 
cerned, without the relief of the symptoms produced. 

Lack of gastric digestion depends for its existence upon a very 
great number of causes, and is always a symptom, not a disease. It 
occurs during the course of short or prolonged fevers from atony of 
the gastric walls and glands, from lack of secretion of the proper 
character, from hypersecretion of mucus by the mucous glands, and 
by fermentative changes in the food, or as the result of any one or 
all of these conditions, and, lastly, because the food is unsuitable to 
the case, or is of a kind difficult of assimilation, or is readily split up 
into effete products by the juices of the organ, and these in turn, being 
absorbed, produce toxic symptoms. Sometimes it is due to organic 
changes in the viscus, as carcinoma or ulcer, and sometimes to acute 
or chronic gastritis. In each of these states the treatment is, of 
course, different, because widely-separated causative factors must be 
removed. 

The indigestion attendant upon the course of fevers can nearly 
always be avoided by a proper diet and the use of predigested food, 
such as pancreatized beef-tea, milk, or broths. The necessity of this 
artificial digestion is the more readily recognized when we recall the 



INDIGESTION. 557 

investigations of Hoppe-Seyler upon the quality of the gastric juice 
of a patient suffering from typhus fever, for he found that no hydro- 
chloric acid was present. Uffelmann has also found in a similar study 
that the peptone-forming secretion of the stomach ceases entirely 
during fever. 

Where indigestion results from the presence of gastric catarrh the 
remedies applicable to such a state must be resorted to. (See Gastric 
Catarrh.) 

The studies made within recent years upon the chemical conditions 
of the gastric contents have changed our methods of treatment from 
being empirical to being rational, for we now know that disorders of 
digestion depend on deficient or excessive acidity of the gastric juice, 
deficient formation of pepsin, deficient motility of the gastric walls, 
and other less important causes. Before carrying out any line of 
treatment the physician must therefore decide, if possible, as to the 
underlying cause of the dyspepsia found in each case, and his decision 
may be based on well-described subjective symptoms by the patient, or 
upon this description aided, or it may be replaced, by examination of 
the stomach-contents after a "test-meal." 

In those cases in which the dyspeptic symptoms result from imper- 
fect mastication and insalivation of food it is evident that careful 
eating rules are to be given the patient, with the additional advice, 
which is equally good in all cases, that exact meal-hours shall be 
adhered to, since irregularity in meal-hours results in imperfect diges- 
tion as commonly as irregularity of habit in regard to defecation 
results in constipation. If the dyspeptic symptoms are due to deficient 
secretion of gastric juice, particularly if it is found that hydrochloric 
acid is the chief deficient element, one of two plans presents itself 
for employment. In many cases it will be found that the administra- 
tion of small doses of bicarbonate of sodium, 5 to 10 grains (0.3-0.65), 
before each meal will cause a free secretion of gastric juice, particu- 
larly if that be given simultaneously with bitter substances which act 
as stimulants to the gastric mucosa. These facts are not based solely 
on the apparent improvement in the patient, but also upon careful 
chemical studies of the acidity of the gastric juice by means of the 
stomach-tube. In mild cases the taking of a glass of Vichy water 
before each meal serves to provide sufficient sodium to produce good 
effects. The bitter substances which it is best to employ in cases of 
deficient acidity of the gastric juice are, among the simple bitters, 
such drugs as quassia, cascarilla, Colombo, and gentian. Among 
the peculiar bitters we have nux vomica, quinme, rhubarb, and con- 
durango. These may be employed in the following forms : 

R. — Sodii bicarbonatis ^j (4.0). 

Tinct. nucis vomica? f^j vel. ij (4.0 vel 8.0). 

Tinct. gentian, comp. . . q. s. ad f^iij (96.0). — M. 
S. — Teaspoonful to a desertspoonful (4.0 to 8.0) before meals. 

If the stomach is lazy and atonic, but with no true disease which im- 
pairs its secreting power, an alkali will, in the majority of cases, prove 
to be the best drug ; but if, on the other hand, there is deficient gas- 



558 DISEASES. 

trie secretion through atrophy of the gastric tubules or carcinoma of 
the stomach, the use of hydrochloric acid is the better plan. Under 
these circumstances the following prescription may be ordered : 

R. — Acid, hydrochloric, dil f^j (4.0). 

Ext. condurango fl ff j (32.0). 

Tine, cardamomi corap q. s. ad ffiij (96.0). — M. 

S. — Dessertspoonful with or after each meal in water. 

The symptoms manifested by persons needing the treatment first 
named are variable, but generally of sufficient constancy in type to be 
fairly pathognomonic. There is generally loss of appetite, some 
impairment in general health and nutrition, and marked difficulty in 
digesting food, particularly if it be in solid form. Complaint is usually 
made of a sensation of weight after eating, without any real pain, 
but indigestion is not complete, owing to the food being finally dis- 
posed of in the duodenum. Often because of the delay in gastric 
digestion there is some belching of gas due to fermentation of the 
food in the presence of warmth and moisture, and without the anti- 
septic influence of the gastric juice. If any food is brought up with the 
belching, it is unaltered or changed only by fermentation. Examina- 
tion of the stomach-contents for hydrochloric acid by the phloroglucin- 
vanillin test will speedily confirm the diagnosis, and this confirmation 
should be sought for in every case. 

In the cases of gastric indigestion depending upon hypersecretion 
ofHhe acid of the juice a line of treatment quite at variance with that 
just discussed must be instituted. This may be divided into the 
direct and indirect forms, including the remedies which distinctly 
decrease gastric secretion and those which antagonize or overcome its 
acidity after it is poured out from the glands. In the first-class we 
find both general and local nervous and glanular sedatives, and in the 
second alkaline drugs. 

Of the first class we have hyoscyamus, belladonna, and opium 
from the vegetable kingdom, and the bromides, bismuth, and nitrate 
of silver from the mineral. Of the second class we have massive 
doses of sodium bicarbonate taken during or after meals, ammo- 
nia, generally in the form of the aromatic spirit, and magnesia and 
chalk. 

As many, if not all, of the cases suffering from hyperacidity are 
of a nervous temperament, these drugs do good by quieting reflex 
activity throughout the nervous system connected with digestion, and 
by a local action on peripheral nerves, or on the glands themselves, 
diminish secretion. Of particular value for this purpose is hyoscy- 
amus, which very markedly decreases gastric secretion directly and 
indirectly, and at the same time relieves gastric pain by its local 
sedative influence. 

Taking gastric ulcer as a typical instance of a condition of 
excessive secretion of hydrochloric acid, it will be found that the fol- 
lowing pill, combined with an absolute milk diet or, for the first few 
days, allowing only rectal alimentation by peptonized food, will be 
most useful : 



INDIGESTION. 559 

R. — Argenti nitratis gr. v (0 3). 

Extract hyoscyami gr. x (0.65). — M. 

Ft. in pil. No. xx. 
S. — One pill one hour before taking food. 

Sometimes in place of this pill it is wise, particularly if no ulcer 
exists, to give 10 to 20 grains (0.65-1.5) of bromide of strontium 
one hour before meals, and in any case where this fails to control 
excessive secretion of acid give full doses of sodium bicarbonate, 
20 or 30 grains (1.5 or 2.0) or more, after each meal. The bromide 
had better be given in solution. If the stomach is very irritable and 
there is a tendency to vomiting, a powder composed as follows is often 
useful : 

R. — Acid, carbolic, (cryst.) Tt\,xx(1.5). 

Bismuthi subnitrat gr. cc. (14.0). — M. 

Ft. in chart. No. xx. 
S. — One t. i. d. with or before food. 

The symptoms manifested by the patients requiring this treatment 
are as follows : There is often a constant sense of gnawing or hollow- 
ness in the stomach, which is sometimes temporarily allayed by the 
taking of food. The patient is, as a rule, of a nervous temperament 
and in a condition of nervous depression due to some exhausting cause. 
Tenderness and even pain in the epigastrium may be produced by 
superficial or deep palpation, or the patient may complain that the 
pressure of his clothes is distressing. If ulcer of the stomach is 
present, all the characteristic symptoms of that lesion may be 
found. When belching occurs, there is often vomiting of sour 
masses or acid eructations or heartburn. Gastralgia more or less 
severe may also occur. 

In cases Avhere testing the stomach-contents shows that the exces- 
sive acidity is not due to hydrochloric acid, but to the acids of fer- 
mentation, the use of the sedative drugs we have named is of no avail 
for obvious reasons, but in their place we may employ sodium bicar- 
bonate as a palliative, and antiseptic or antifermentative drugs, such 
as thymol, creosote, chloral, and sodium hyposulphite, as direct reme- 
dial agents. Lavage of the stomach should also be resorted to. 

In still other cases a mixture containing chloral and hyposul- 
phite of sodium is useful because of its antiseptic influence. (See 
Chloral.) 

Often these cases are relieved if all fats, and butter in particu- 
lar, are excluded from their diet-list. 

If much gas is developed and a sensation of weight in the stom- 
ach is felt after eating, so that the patient feels as if the food lay 
undigested in that organ, the prescription to be found at the top of 
the next page may be used, but is contraindicated if the stomach is 
tender on deep palpation, or, in other words, if acute irritation or 
inflammation of the stomach is present. It is useful in atonic states 
of the stomach, and it is surprising how much relief may be afforded 
by the use in such cases either of this prescription or of one of the 
volatile oils, such as oil of cinnamon, given in capsule or pill after 
meals. 



560 DISEASES. 

R. — Oleoresin. capsici TT^ij (0.1). 

Pepsin, vel pancreatin gr. xx (1.35). 

Pulv. zingiberis -. . . . . gr. xx (1.35). 

Carbo ligni gr. xl (2.65). 

Creosoti tt\x (0.65). — M. 

Ft. in pil. No. xx. 
S. — One after eating. 

Intestinal indigestion depends upon almost the same causes as does 
gastric dyspepsia, and is to be treated in much the same manner, chiefly 
by a careful study and regulation of the patient's diet, and by the use 
of a number of remedies calculated to supplant to some extent the 
normal juices by some artificial ferment. These ferments should be 
given with the meals or the food predigested before it is taken. 

The pancreatin should be given in good dose (5 to 10 grains [0.3- 
0.65]), with bicarbonate of sodium, and alkaline mineral waters used 
if the urine is concentrated. (See Biliousness.) 

Sometimes where intestinal indigestion is present great flatulence 
comes on, and is an annoying symptom. Very commonly in these 
cases it will be found that the patients think they have heart disease 
because of .the pain they suffer under the prsecordium. This pain is 
due to the accumulation of flatus in the small intestine, or more com- 
monly to its pressing upward at the angle where the transverse colon 
turns to go down to form the descending colon and sigmoid flexure. 
Under these circumstances the following prescription will be found 
of service : 

R.— Acid, nitric, dil f^j (4.0). 

Tinct. cardamom, comp fjyj (192.0). — M. 

S. — Dessertspoonful (8.0) in water four times a day. 

In old persons flatulence of the large bowel is frequently found, 

and is often associated with atony of the muscular coats of the gut. 

Under these circumstances the following prescriptions will be found 
of service : 

R.— Asafcetidse . . . . ^ gr. xl (2.6). 

Extract, nucis vomicae gr. iv (0.25). 

Extract, physostigmatis gr. iij (0.18). 

Oleoresin. capsici rt^x (0.65). — M. 

Ft. in pil. No. xx. 
S. — One pill three times a day, two hours after meals. 



Or, 



R.— Tinct. belladonna? f^ij (8.0). 

Tinct. physostigmatis f^j (4.0). 

Spt. camphorse q. s. ad fgiij (96.0). — M. 

S. — Teaspoonful (4.0) two hours after meals or whenever needed. 



Where intestinal indigestion results in lientery the treatment 
becomes entirely changed, except in regard to the use of a predi- 
gested milk diet, and efforts must be made to increase the secretion 
of the glands of the intestinal wall. Often minute doses of mercurv 
bichloride or podophyllin may do this, -fa to fa grain (0.001-0.0016) 
of the first or second, respectively. More commonly, however, the 
mixture of nitric acid, given above, will be the proper treatment, or 
perhaps the following if the liver is found to be torpid : 



INFLUENZA. 561 

R.— Acid, nitro-hydrochlor. (not dil.) • . . f^ss vel f£j (2.0-4.0). 

Infus. gentianae comp q. s. ad fjvj (192.0). — M. 

S. — Dessertspoonful (8.0) every four hours or after meals, in water. 

Chloroform spirit is often valuable in these cases in the dose of 
20 drops (1.3). (See Chloroform.) 



INFLUENZA. 

The disease known as influenza affects various individuals so 
differently, and presents so many symptoms associated with functional 
disorder of various organs in the body, that it is almost impossible to 
do more than consider the remedies which are to be employed in the 
treatment of the more frequent or more immediate manifestations or 
complications. Greater in importance than the employment of drugs 
must be regarded continuous rest, and stimulants are in many cases 
absolutely essential. 

In those cases in which the disease is ushered in by a severe chill, 
accompanied by violent pains in the back, if the patient is seen early 
enough it may be necessary to employ remedies for the relief of the 
rigor, with the double purpose of improving the patient's general con- 
dition and preventing internal congestion of vital organs. In the 
majority of instances, however, the patient will not be seen during 
this period of the disease, but during the febrile stage, which succeeds 
that just mentioned. Under these circumstances the author does not 
believe that it is well for the physician to resort to any of the rem- 
edies which have been so largely used during the last few years, and 
which are known as the " antipyretics " or the derivatives of coal- 
tar. Although originally introduced for the purpose of reducing 
febrile temperatures, practical experience has taught us that their 
sphere of action is very limited under these circumstances, and the 
author almost never gives antipyrine. phenacetin, or acetanilid with 
the object of reducing fever. Although he does not believe that 
these remedies are to be used for the reduction of temperature, he 
has certainly seen very marked relief follow their employment with 
the object of relieving the severe pain which occurs in the back, 
limbs, or head. Small doses are usually sufficient to at least reduce 
the suffering, if not to remove it entirely, but. as cardiac complica- 
tions are by no means unusual, large doses are contraindicated in 
most persons. The author prefers to allow- the patient to suffer from 
a moderate degree of pain rather than from the dangers incident to 
the administration of doses large enough to entirely relieve it, because 
in his experience these closes have to be very large if they are to be 
entirely competent as analgesics in influenza. 

If any of the coal-tar products are used either for the relief of 
fever or of pain, phenacetin and antipyrine should be chosen. Ex- 
periments made in America and in Germany on animals have proved 
that phenacetin is far less toxic in its relations to the heart than is 
antipyrine or acetanilid, and while it has in a number of instances 
seemed more inclined to produce cyanosis in man than either of the 

.30 



562 DISEASES. 

other drugs, this cyanosis rarely, if ever, has been associated with 
any other dangerous symptoms. Indeed, it is quite extraordinary 
the amount of cyanosis which phenacetin may produce without the 
respiration becoming greatly disordered, very much less cyanosis 
when caused by acetanilid or antipyrine being accompanied by much 
more alarming symptoms. A very favorite combination with prac- 
titioners who have had a large experience is one of salol and phena- 
cetin. The action of the phenacetin in relieving the pain and in 
reducing the fever seems to point to it as a rational remedy, but the 
exact influence of salol under these circumstances is not so clear. 
Composed, as it is, of 60 per cent, of salicylic acid and 40 per cent, 
of carbolic acid, it seems to possess a therapeutical power different 
from that possessed by either of these two constituents alone, for 
neither carbolic acid nor salicylic acid has much power in the relief 
of pain when used alone, unless, as in the case of carbolic acid, it 
is applied directly to the part affected. Perhaps the condition of 
pain in the lumbar and other muscles during the attack of influenza 
is in some unknown way associated with the condition which we 
have called lt rheumatism," and in which salicylic acid does good 
in an unknown manner. Salicylic acid alone might be equally use- 
ful if it were dissolved in the intestine and did not irritate the 
stomach. 

On seeing a case of influenza during the first few hours of the 
attack the author resorts to those remedies which have been in use 
by the profession for many years, and, so far as he can learn, it is 
the custom of other members of the profession to give a mixture 
composed of tincture of aconite, spirit of nitrous ether, and a solu- 
tion of citrate of potassium in preference to any other medicine at 
this time. This mixture possesses the advantage of increasing the 
action of the skin and kidneys, and of reducing the temperature, of 
quieting the circulation, and of being readily taken by the patient 
without danger of disordering the stomach at this time or later on, 
which is important, as this organ is apt to become irritable. As a 
general rule, citrate of potassium is given in too small doses, and, 
unless there are reasons to the contrary, it should be given in the 
dose of 15 to 20 grains (1.0-1.3) three times a day to an adult. 

If the fever becomes excessive, so that there is danger of the 
patient suffering from a true hyperpyrexia, it is better to resort to 
cold bathing instead of the antipyretics just spoken of. It is true 
that the patients themselves and the friends of the patients will some- 
times protest against what they deem an heroic measure, but the 
author is satisfied that if the cold is used in the proper manner it is 
devoid of danger to the patient. The majority of physicians do not 
seem to carry out the treatment of Brand and Liebermeister as it is 
carried out by its originators. Most of them forego the very import- 
ant portion of the treatment, which consists in frictions designed to 
bring the heated blood to the surface, and the author has again and 
again seen physicians apply cold either by means of a wet sheet, by 
sponging, or a cold bath without using any measures which are di- 
rected against internal congestion. (See Cold and Fever.) 



INFLUENZA. 563 

Hyperpyrexia in influenza does not seem to possess the same dangers 
that it does in the course of some other diseases. In the first place, as 
a general rule, the course of the disease is a brief one, and, although it 
may leave the patient weak and exhausted, the duration of the febrile 
portion of the malady does not extend beyond a few days. Clinical 
experience and physiological study have proved that it is not the tem- 
perature of 105° or 106° F. which is distinctly dangerous, but the 
continuation of this temperature for many hours which is harmful. 
Similarly, a patient ill from typhoid fever, having a temperature of 
103° for many days, suffers very much more than does a patient who 
is suffering from pneumonia, and who may have for forty-eight hours 
a temperature of 104.5° or 105°. For these very reasons a tempera- 
ture of 104.5°or 105° is not particularly alarming in the condition 
which we are considering, unless there are symptoms pointing to the 
fact that the patient is being injured by an excessive temperature, as 
may be indicated by somnolence and an exceedingly dry skin as well 
as cerebral symptoms. Of course, if renal trouble, associated with 
cardiac disease, comes on at this time, methods for the reduction of 
the temperature must be resorted to. The point to be strongly 
emphasized is that the mere existence of high temperature is not to 
be regarded as a condition to be overcome by the use of drugs. 

It seems to be the general consensus of opinion, both in this coun- 
try and in England, that any measures of a depleting character are 
distinctly harmful in influenza, even at its earliest stages, and we 
would naturally expect that this would be the conclusion arrived at 
by physicians who treat their patients rationally. Although influenza 
is a short-lived disease, there is probably no malady in which the 
patient goes so quickly into a condition of profound depression, or 
even exhaustion, as in this one. The abstraction of blood from a 
vein or by the use of cups should not be resorted to, as it will increase 
the exhaustion. Before the system has a chance to recover from the 
appearance of the attack he will be still further depressed by the thera- 
peutic measures of the physician who is unwise enough to bleed. 

As the case of influenza progresses a condition of marked depres- 
sion, or even collapse, very frequently develops. The expression of 
anxiety on the patient's face is to a physician who is accustomed to 
see it in other diseases a most alarming symptom, and it is not until 
one has seen it repeatedly in influenza that he is able to give it its 
exact value. Associated with this condition, the skin is frequently 
covered with a profuse perspiration, and the pulse is very apt to be 
very rapid, running, feeble, and easily compressed. At first glance 
the old saying, that "we treat the symptoms as they arise," would 
seem to cover to a very large extent the indications which are present 
at this period ; yet the author's experience, which may differ from that 
of some of his readers, is that the cardiac stimulant which we are 
most frequently accustomed to use — namely, digitalis — does not seem 
to take hold of the circulatory apparatus and to act upon it in the 
manner which is desired. It may be that the pressing symptoms 
have made us more anxious and impatient as to the use of any medi- 
cament, and that we have not had the patience to wait and allow such 



564 DISEASES. 

a slowly-acting remedy as digitalis to take effect. Be this as it may, 
the author regards strychnine as infinitely preferable to foxglove 
when these symptoms appear ; and he has been able to prevent 
their appearance, or at any rate to modify them to a very great 
extent, by using strychnine in full doses from the first portion of the 
stage of depression. We believe that, as a general rule, strychnine 
is given in very much smaller doses than safety requires, and that in 
many instances it fails to act because the doses are too small to strug- 
gle with the profound condition of exhaustion which is present. In 
an adult we can see no reason why -fa of a grain (0.003) may not be 
given three or four times in twenty-four hours, and in some cases we 
have given it every four hours without producing any of the symp- 
toms of an overdose of strychnine. Divided doses are better than a 
few very large ones. 

The author knows of no better illustration of the fact that in some 
conditions we are to give drugs for effect rather than according to 
customary dose than the employment of strychnine in influenza, and 
the physician who is timorous in the presence of this frequent com- 
plication, depression, certainly increases the patient's danger. As 
with everything else, the drug should be carefully watched, and at 
the first sign of muscular twitching or stiffness at the back of the 
neck its administration should be cut down or discontinued. In 
many instances where the collapse comes on suddenly the strychnine 
should be administered hypodermically and followed by full doses by 
the mouth, in order to keep up the full effect exercised by the drug 
upon the nervous and circulatory systems. In some cases it will be 
found that the blood-paths seem to be so relaxed and atonic that the 
strychnine is unable to produce a sufficient vascular effect to bring 
the patient out of his difficulties, and under these circumstances very 
good results follow the combination of belladonna with strychnine, 
the belladonna being, as we well know, a powerful vasomotor stim- 
ulant under such circumstances. It also should be given in full doses 
for effect. As the acute stage of depression passes off the belladonna 
should be stopped and the strychnine continued alone through con- 
valescence. 

Alcohol has not seemed to be of much value during the active 
period of the disease. In milk-punches and eggnogs it is of course 
useful during convalescence. 

If delirium comes on, it has not seemed to be a symptom of very 
serious character either for immediate results or in influencing the 
prognosis as to the ultimate recovery of the case, and in cases of 
pneumonia complicating grippe, in which delirium is the prominent 
symptom, it appears that delirium is not to be regarded in the same 
light as similar manifestations complicating ordinary pneumonia or 
other diseases. The delirium may be either talkative or muttering, 
but does not in the majority of cases require treatment, passing away 
with the fever and rarely extending into the stage of exhaustion. 

For the irritative cough steam inhalations, laden in the first stage 
with benzoin or other innocuous and sedative substances, seem par- 
ticularly useful. For the bronchitis which is often present it is gen- 



INFLUENZA. 565 

erally sufficient to administer the ordinary mixtures, containing ipecac 
and potassium citrate, in the earliest stages, and to follow them by 
chloride of ammonium and cubebs in the later stages. The author 
does not think that the compound liquorice mixture containing anti- 
mony should be given in the second stage of influenza. A complica- 
tion too apt to occur at this time is oedema of the lung or a wide- 
spread bronchitis, with a profound exudation which bids fair to drown 
the patient in his own secretions. Antimony is not only a substance 
depressing to the circulatory and respiratory systems, but aids very 
materially in causing the peculiar excess of secretion which has just 
been spoken of. 

It may be necessary to use bromides if the cough is excessive, or 
to replace them by codeine or very small doses of morphine. In many 
cases still better results will be obtained by a good preparation of 
cannabis indica, which may be pushed until it relieves the cough 
without in any way endangering the patient's life — a safety which 
cannot be obtained by the employment of any other of the drugs 
named. 

If sleeplessness is so pressing a symptom as to require attention, 
the bromides may be given, but it will be generally found that the 
insomnia comes after the attack rather than during it, or in -any event 
it will not require attention until the patient is convalescent. Under 
these circumstances chloral or chloralamide, or even sulphonal, may 
be administered, care being taken, of course, in the case of chloral 
that the cardiac apparatus is in good condition, and in the case of 
sulphonal that it is administered in a powdered form or dissolved in 
hot water and given four or five hours before the time at which sleep 
is desired. 

For the vertigo and dizziness which are sometimes bitterly com- 
plained of by the patient either during or after the attack, small doses 
of bromide with ergot or cannabis indica have seemed particularly 
valuable, probably because they exercise some effect upon the blood- 
vessels of the brain or its membranes or perhaps upon the blood-ves- 
sels of the ear. Certain it is that in those cases of tinnitus not asso- 
ciated with organic change in the aural canals bromides and ergot do 
more toward relieving them than any other medication. 

In the constipation which is sometimes present in the early stages 
of influenza it is generally advisable to administer either castor oil or 
in other cases half an ounce (16.0) of the sulphate of magnesium, or 
for more fastidious patients the citrate of magnesium. A full purga- 
tive effect of any of these salines seems to lessen the fever when the 
bowels are unloaded. Care should be taken that the dose of the purga- 
tive is not excessively large, as it will weaken the patient as much as 
would bleeding. For the constipation following the attack probably 
no drug is as efficient as cascara sagrada, combined perhaps wiih 
aloin. (See Constipation.) If diarrhoea supplants the constipation, 
the ordinary astringents, such as aromatic sulphuric acid or hsematox- 
ylon, will be found sufficiently active. (See Diarrhoea.) 



566 DISEASES. 

INSOMNIA. 

Insomnia is a condition characteristic of many diseases, and arises 
from such a host of causes that the physician may not be able to dis- 
cover any one of them for days after the patient is first seen. As a gen- 
eral rule, a patient consulting a physician with this symptom expects 
a prescription to be given at once and the cause of the insomnia found 
out afterward, or, in other instances, wilfully defeats all the efforts of 
the practitioner for one reason or another, but desires relief, although 
he may not choose to aid in its attainment. Under these circum- 
stances the physician may safely employ certain drugs according 
to the information that he may have concerning the patient's state. 

One of the most common remedies is chloral given in the follow- 
ing manner : 

R.— Chloralis ^iij (12.0). 

Syr. simplicis f^iv (16.0). 

Aquae cinnamomi q. s. ad fjiij (96.0). — M. 

S. — Dessertspoonful (8.0) at night. 

Or, 

R.— Butyl chloral-hydrat 3J (4.0). 

Ft. in pil. No. xii. 
S. — One, two, or three pills at night, as needed. 

Where, for any reason, as the presence of a weak heart, chloral 
is contraindicated, resort may be had to the bromide of potassium 
or sodium, and if the patient is a female these drugs should always 
be accompanied by a small dose of arsenic, generally in the form of 
Fowler's solution, 1 to 3 drops (0.05-0.15) three times a day, in order 
to avoid all danger of the production of acne. The following pre- 
scription is useful : 

R. — Potassii bromid ^ij (8.0). 

Liq. potassii arsenit f^ss (2.0). 

Aquse cinnaraomi q. s. ad f^vj (192.0). — M. 

S. — One to two dessertspoonfuls (8.0-16.0) at night. 

In many cases larger amounts of the bromide will be needed. 

Where the sleeplessness is due to pain, chloral is of little value and 
bromides are worth but little more. Under these circumstances by 
resorting to what is known as the " crossed action of drugs," we can 
often obtain a very good effect. Thus morphine and chloral both act 
on the brain to produce sleep, or, in other words, their action is here 
crossed, for one relieves pain and the other does not ; one kills by 
failure of the heart in overdose, the other by respiratory failure ; as 
a consequence, large doses of neither can be given alone. The fol- 
lowing is therefore a useful combination, either where one drug fails 
or when dangerously large doses of either alone have to be used to 
obtain the desired result : 

R. — Morphinse sulphatis gr. iv (0.2). 

Chloralis = ^ij (8.0). 

Aquse . . q. s. ad fg'iv (128.0).— M. 

S.— Dessertspoonful (8.0) at night. 

In cases where insomnia is due to mania hyoscine is said to be very 
useful, given in the dose of T ^ to -fo grain (0.0007) by the mouth 



INTERMITTENT FEVER. 567 

or j^-q to T -J-Q- (0.0006) by the hypodermic needle. Owing to its taste- 
lessness the powder may be put on the tongue, and it is best to order 
a little sugar of milk or white sugar (1 grain) to every small dose of 
hyoscine, in order to give it bulk. 

Where insomnia follows mental effort avoidance of all cerebral 
activity should be insisted upon during the evening, and if the feet 
are cold on going to bed sleep should be induced by a hot foot-bath or 
the use of a hot-water bag at the feet and cold to the head. 

During the last few years a very large number of remedies have 
been introduced as hypnotics, such as somnal, paraldehyde, chloral- 
amide, sulphonal, amylene hydrate, hypnal, and others. Not one 
of these is comparable in therapeutic activity with the older remedies, 
although sulphonal and chloralamide seem to be the best of the lot. 
The dose of sulphonal is 10 to 20 grains (0.65-1.3) in powder, but, 
as it is large in bulk and hard to swallow, it should be used in a pre- 
scription made up as follows : 

R. — Sulphonal gr. xxx (2.0). 

Syrupi simplicis fgij (8.0). 

Mucilaginis acacise f£ij (8.0). 

Aquse destillat q. s. ad f5j (32.0).— M. 

S. — Half to all of this at one dose, as may be needed. 

In other instances sulphonal may be dissolved in very hot w T ater, and 
the solution swallowed before it cools sufficiently to permit precipi- 
tation. 

Chloralamide may be used in the dose of 15 to 60 grains (1.0-4.0), 
dissolved in wine or given in capsule. Paraldehyde is given in the 
dose of 20 to 60 minims (1.3-4.0). As it is disagreeable in odor and 
taste, it must be given in capsule, and it is very apt to disorder the 
stomach. 

The dose of amylene hydrate is the same as that of paraldehyde. 
It is a liquid, and, like the rest of the drugs named, with the excep- 
tion of hypnal, has no effect in insomnia from pain. 

Somnal is used in the dose of 10 to 40 minims (0.65-2.65) with 
liquorice and water, and possesses considerable power. 

In the treatment of insomnia it should be remembered that if pos- 
sible those drugs should be used which will quiet the part of the brain 
which is most active. Thus if the patient tosses much, we use bro- 
mides and chloral as motor depressants. If sensation is active, bro- 
mides and the hot pack are used to act as sensory quietants. In 
other cases horseback exercise taken late in the afternoon does good, 
particularly if the patient follows a sedentary life. Many persons 
who are usually sleepless will obtain a refreshing slumber by taking 
a very light and easily-digested meal just before retiring for the 
night or by eating a cracker or drinking a glass of milk when they 
awake during the night. 



INTERMITTENT FEVER. 

In all forms of intermittent fever, whether the attacks are diurnal, 
quotidian, tertian, or quartan, the best remedy for their prevention is 



568 DISEASES. 

quinine, which should under these circumstances be given ahout two 
or three hours before the attack is expected, so as to be absorbed and 
be physiologically active when the paroxysm is due. This precaution 
is often overlooked, and the dose ordered at the time of the expected 
attack, with failure as a result. Not only should sufficient time 
elapse for absorption, but the fact should be remembered that the 
chill often begins an hour earlier each day, and will be in full sway 
before the quinine can stop it if the drug be not administered at the 
proper time. Experience has proved that quinine never acts as favor- 
ably if constipation is present as when the bowels are lax, and hepatic 
activity seems particularly necessary for its full effect. To obtain the 
full influence of the drug it should be preceded, by some four or five 
hours, by -^ to J grain (0.010-0.016) of calomel every fifteen minutes 
until a grain (0.05) is taken, or by a dose of podophyllin amounting 
to -^-q to -J- grain (0.006-0.008). If podophyllin is used, a longer 
time should be allowed before the antiperiodic is given, because of the 
slow action of this purgative, and if the patient has been rendered 
unusually insensitive to purgatives, larger doses of both the remedies 
named must be used ; particularly is this true in the South. , 

The dose of quinine varies with the exigencies of the case, which 
in turn generally depend upon the region in which the patient lives 
or has lived. 10 to 15 grains (0.65-1.0) in one close are generally 
sufficient in the Eastern and Northern States, but as much as 20 to 
45 (1.3-3.0), or even 60 grains (4.0) may be required in the south- 
ern parts of the United States and elsewhere. When still larger 
doses are employed, the drug should be given partly hypodermically 
and partly by the rectum in suppository or in solution, as well as by 
the stomach, as this viscus will rarely withstand 60 grains (4.0) of 
quinine without irritation. (For the best salts for hypodermic use, 
see article on Cinchona, page 148.) If the stomach is irritable, 
resort to these means of entrance into the body are absolutely neces- 
sary and must be entirely relied on. 

In cases where the attacks are several days apart small doses of 
quinine of from 3 to 6 grains (0.15-0.3) are to be taken daily between 
the paroxysms, or, what is better, arsenic may be given in moderate 
dose for its antiperiodic influence during the intermission. In this 
manner the quinine acts with full force when most needed. 

Having considered the prophylaxis of a chill, let us turn to the 
treatment of the attack itself. It must be remembered that the 
greater part of the harmful effect of the malarial poison is exerted at 
this time by the internal congestions and engorgement of the abdom- 
inal and thoracic organs. The physician should therefore try to pre- 
vent, as far as possible, too great a rigor, and if stasis results from 
the chill, overcome it, not by depletants, unless the case is very 
sthenic, but by stimulants, such as strychnine or digitalis, which will 
drive out the blood from the congested area! 

If a full meal has just been eaten, the stomach should be emptied 
by an emetic dose of ipecac, 2 drachms (8.0) of the powdered drug 
to an adult, or by 20 grains (1.3) of sulphate of zinc. It is almost 
useless to give quinine at this time, as absorption from the stomach 



IRITIS. 569 

and subcutaneous tissues is almost entirely absent. Alcoholic stimu- 
lants are not to be employed, as clinical experience seems to indicate 
that they act unfavorably. 

If the chill is severe enough to endanger the patient's life, meas- 
ures must be used to control it. Chloroform may be inhaled, and 
immediately preceded by laudanum by the bowel or mouth. If the 
laudanum is given by the mouth, a little ether or chloroform may be 
added to the dose of the opiate. The opium may be used hypoderm- 
ically in the form of morphine in the dose of -^ of a grain (0.01) com- 
bined with -g 1 -^ of a grain (0.001) of atropine. 

In the fevered stage little can be done except to give the patient 
comfort by cool drinks and cool sponging, or, if the fever becomes 
excessive, by the use of antipyrine or the ice-pack. The latter has 
seldom to be used, as the fever is generally too fugitive to need such 
measures. 

The sweating stage needs no particular treatment, unless exhaus- 
tion is caused by it, when stimulants may be cautiously used as 
needed, and large draughts of water at ordinary temperatures swal- 
lowed. 

Many measures have been resorted to to put off a malarial attack, 
the chief of which is the use of ether or chloroform anesthetization 
at the time of the expected paroxysm, of nitrite of amyl or of the 
nitrite of potassium or sodium in 10-grain (0.65) dose for the same 
purpose. Where the "chill habit" exists and depends largely upon 
nervousness, it has been broken by misplacing the hands of the clock, 
and so getting the patient past the time for his attacks without his 
knowledge. 

It should be remembered that the use of quinine in malarial 
fevers is no longer based on empiricism, but upon the fact that the 
drug exerts a peculiarly lethal influence over the cause of the dis- 
ease, the Plasmodium malariw of Marchiafava and Celli, or, as it is 
sometimes called, the malarial germ of Laveran or the hrematozoon 
of malaria. 

It is worth remembering that methylene blue possesses antimala- 
rial properties in the dose of 1 to 4 grains (0.05-0.2). (See Methyl- 
ene Blue.) 

IRITIS. 

Iritis, or inflammation of the iris, as usually encountered is caused 
either by syphilis, rheumatism, or gout. It may also be traumatic : 
less frequent causes are gonorrhoea, diabetes, malaria, and tuberculo- 
sis. Metastatic iritis occurs in pyaemia, relapsing fever, etc. The 
most marked symptoms are severe brow pain ; fine ciliary injection ; 
discoloration of the iris and immobility of the pupil, due to the for- 
mation of adhesions between the iris and the capsule of the lens. 
The most important local remedy is atropine, to be used every two 
hours according to circumstances. If for any reason this is not 
tolerated, duboisine, scopolamine, or daturine may be substituted. 
Cocaine increases the mydriatic power of atropine. 



570 DISEASES. 

Pain may be relieved by leeches to the temple and the use of dry 
heat externally (cotton batting heated over a register will suffice) or 
not fomentations — water, chamomile infusion, or laurel-water (1 : 15). 

In traumatic iritis iced compresses are suitable in the early stages, 
but not in the later periods and not in any other form of iritis. Great 
care must be taken not to mistake iritis for conjunctivitis on the one 
hand, and glaucoma for iritis on the other; delayed use of atropine 
and the employment of astringents on account of the former error, 
or the instillation of atropine because of the latter, would constitute 
a serious therapeutical blunder. In serous iritis, or that variety in 
which there is a hypersecretion of the aqueous humor, which becomes 
turbid, and a precipitate of dark spots occurs upon the membrane of 
Descemet, atropine must be cautiously instilled, owing to the tend- 
ency to increased tension. If this occurs, paracentesis of the cornea 
may be needed, and pilocarpine should be given internally if the vit- 
reous becomes opaque. 

Subconjunctival injections of sublimate (2-5 drops of a 1 : 2000 
solution) are recommended in syphilitic iritis, and, if the inflamma- 
tion is not too acute, produce good results. 

In true syphilitic iritis mercury must be pushed to the point of 
tolerance, but it is not necessary to salivate the patient. Any form 
of mercury usually employed in secondary syphilis may be used — 
calomel, blue mass, or protiodide of mercury — but the most efficacious 
method is by inunction : this is preferable even to hypodermic medi- 
cation in the opinion of many authors. After the mercurial impres- 
sion has been made and the pupil is well dilated, potassium iodide, 
either alone or in combination with bichloride of mercury, is indicated. 

In plastic iritis, appearing six to eight months after the disappear- 
ance of the secondary symptoms, this latter treatment without the 
previous use of mercury has been recommended. Carmichael's plan, 
consisting in the administration of drachm doses of turpentine, in 
addition to which the potassium iodide may be given, receives the 
endorsement of some surgeons and is useful in serous iritis. 

Rheumatic iritis calls for salicylic acid, oil of gaultheria, and, 
later, potassium iodide ; in the chronic types of the affection Zolli- 
coffer's mixture is an excellent remedy. Potassium iodide should be 
administered in gonorrhoeal iritis, and relief occasionally follows a 
pilocarpine sweat. In all forms of iritis the treatment of the consti- 
tutional disorder which has occasioned the local inflammation is neces- 
sary, and if the iritis becomes purulent surgical interference is usually 
required. In any variety of iritis the intense pain should be alle- 
viated with morphine or other anodyne sufficiently active to secure 
sleep. During the course of the disease saline laxatives may be 
administered, and after the subsidence and cessation of the specific 
treatment a course of iron tonics is an excellent routine practice. 

KERATITIS. 

Keratitis is the name applied to the various types of inflammation 
of the cornea. If this inflammation is associated with a breach in 



KERATITIS. 571 

the continuity of the corneal surface, it is termed corneal ulcer, and 
four characteristic symptoms supply the indications for local treat- 
ment : (1) photophobia, or dread of light ; (2) blepharospasm, or spas- 
modic contraction of the orbicularis muscle ; (3) congestion of the 
blood-vessels ; (4) pain ; while any existing dvscrasia or constitutional 
condition upon which the local disease may depend requires general 
medication. 

Interstitial Keratitis. 

Interstitial keratitis is that form of chronic diffuse inflammation 
of the cornea characterized by ciliary congestion and a ground-glass 
appearance of this membrane, most common between the ages of five 
and fifteen years, and in the vast majority of cases the result of 
inherited syphilis. No local measure is sufficient, antisyphilitic treat- 
ment being of paramount importance. During the height of the 
ciliary congestion Avarm antiseptic lotions and atropine are indicated, 
the latter especially to prevent the tendency to iritis. Severe pain 
may be alleviated by the use of a leech to the temple if the subject 
be of sufficient age to justify the employment of local bleeding. 

Various other types of keratitis are described as the result of con- 
stitutional disturbances, such as gout (Hutchinson), malaria (Kipp, 
Van Milligen), or any condition of the system associated with great 
exhaustion, such as irregularities in the menstrual functions, certain 
forms of pulmonary disorders (true herpes of the cornea, Horner). 
The local management of these cases does not differ from that which 
has been described. The coexisting constitutional disturbances must 
be combated with suitable remedies. 

Phlyctenular Keratitis. 

Phlyctenular keratitis appears in the form of small, blister-like 
bodies, sometimes single, sometimes multiple, frequently situated 
directly at the corneo-scleral margin, which become yellow, break 
down, and leave an open ulcer (phlyctenular ulcer), to which runs a 
leash of injected blood-vessels. The disease is common in children, 
often follows in the wake of the exanthemata, and is so frequently 
associated with a strumous diathesis that it was formerly called 
strumous ophthalmia. In the majority of cases there is coexisting 
nasal disease, especially adenoid vegetations, which is responsible for 
the frequent relapses of the disorder, even if does not cause it. 
Congestion may be relieved by frequent irrigation with a warm 
boric-acid solution. Pain and irritation call for the use of atropine 
drops (4 grains to the ounce [0.2 : 32.0]), which should be continued 
until the ulcer is covered with regenerated epithelium, when the 
process of cicatrization may be hastened by the insertion daily into 
the conjunctival sac of a small quantity of yellow-oxide-of-mercury 
salve or dusting it with finely-powdered calomel, providing the patient 
is not taking at the same time any form of iodine. During the whole 
treatment the eyes should be protected by dark glasses and the sub- 
ject permitted to go out into the open air. All local treatment will 
prove unsatisfactory unless associated with strict hygiene, carefully 



572 DISEASES. 

regulated diet, and constitutional measures — tonics and alteratives — 
and the treatment of the naso-pharyngeal lesions. 

If the photophobia becomes distressing in spite of the other treat- 
ment, it has been suggested that this may be relieved by the use of 
cocaine, a practice that by no means commends itself in corneal ulcera- 
tion, in spite of the temporary relief from the local anaesthesia. Relief 
of this symptom in many instances follows the use of a douche of cold 
water on the closed eyelids, or by touching with blue-stone the ulcer- 
ated fissure at the external commissural angle, which is commonly an 
exciting cause of the spasmodic closure of the lids. 

Suppurating- Keratitis. 

Suppurating keratitis, or that form of inflammation characterized 
by the formation of pus in the cornea, may be either diffuse, as, for 
example, a complication of purulent ophthalmia, or circumscribed, 
forming an abscess of the cornea. If the pus gathers in the bottom of 
the anterior chamber, the condition is called hypopyon and the dis- 
ease hypopyon keratitis. These conditions require prompt treatment — 
namely, frequent application of hot compresses, Avhich may be advan- 
tageously composed of slightly carbolized water, atropine drops, or, 
in the opinion of many, eserine (J to 2 grains to the ounce [0.03- 
0.1 : 32.0]), If the abscess forms, the pus should be evacuated by a 
formal operation, either by dividing the anterior surface or by per- 
forming the operation after the manner of Saemisch. 

In addition to the types of disease which have been described we 
have the examples of sloughing or infective ulcers, which are seen 
under a variety of conditions, and often are directly traceable to an 
injury, being more common in elderly people. The tendency of all 
these ulcers is to spread, from whence one important variety has 
received the name serpiginous. The mild measures are antiseptic 
lotions, either boric acid or bichloride of mercury, iodoform, hot com- 
presses, and instillations of either atropine or eserine. Formerly 
atropine was almost exclusively used ; in recent years eserine has been 
much employed. It certainly has the power of limiting a sloughing 
process in the cornea. Threatened perforation may be averted by a 
pressure bandage. This is made by placing upon the eye a wad of 
antiseptic cotton, over which, in figure-of-eight turns, a flannel roller 
is applied. If in spite of this the process continues, the following 
measures have met with the greatest success : Touching the margin 
of the ulcer with a strong solution of nitrate of silver, 10 to 20 grains 
to the ounce (0.65-1.3 : 32.0), care being taken that the ulcer alone 
receives the application ; scraping the floor of the ulcer with a small 
curette or spud and dusting upon its surface iodoform ; finally — and 
this, in cases in which the ulceration is not too extensive, is the best 
method — the use of the actual cautery. In every case of sloughing 
ulcer the lachrymal passages must be explored for obstruction. 

Sequelae of Corneal Ulceration. 
After healing of a corneal ulcer the cicatrix consists of a more or 



LARYNGITIS. 573 

less dense white spot in the cornea (macula). If these scars are thick 
and white, the} 7 are irremediable by local medication and require sur- 
gical interference for optical relief. If, however, they are diffuse, 
much good will follow systematic massage of the cornea, aided by 
the introduction of a small particle of yellow-oxide-of-mercury salve. 
The massage is performed as follows: A piece of the salve the size 
of a split pea is introduced beneath the upper lid ; upon the closed 
lid a finger is placed, and regular motions made through the lid over 
the surface of the cornea — namely, vertical, lateral, and radial motions, 
the seance being completed by circular movements. The whole should 
last from one to three minutes. Alleman claims excellent results in 
dissipating corneal opacities by the use of electricity by connecting a 
suitably prepared electrode with a battery, the cathode being placed 
directly on the previously anaesthetized cornea and the anode on the 
cheek. 

LACHRYMAL ABSCESS. 

Lachrymal abscess results from suppuration in a chronically dis- 
tended lachrymal sac, owing to the presence of obstruction in the 
nasal duct, and exists as a SAvelling under the skin at the inner can- 
thus, pressure upon the surface causing an escape of pus through the 
canaliculi. The treatment is practically confined to surgical inter- 
ference — that is, division of the canaliculi and washing out the dis- 
tended sac with antiseptic fluids, and restoring the patulency of the 
nasal duct by the use of probes as soon as the inflammatory symptoms 
have subsided, or, if the skin over the seat of the abscess is thinned 
and rupture is threatened, by free puncture downward and outward. 
In purulent discharge from the lachrymo-nasal duct solutions of blue 
pyoktanin (1 : 1000), injected through the passage, favorably modify 
the unhealthy secretions. Much comfort will ensue from the use of 
hot compresses over the inflamed area. These may be made in the 
ordinary way, or are still more efficacious if composed of a lead 
lotion, the ordinary lead-water and laudanum answering the purpose 
very well. 

LARYNGITIS (ACUTE). 

The treatment of acute laryngitis is identical in many respects 
with that directed against acute inflammatory processes elsewhere. 
It may be divided into local, external, and internal methods. The 
condition of the lar} r nx at this time is that of intense hyperemia and 
irritation, and the object must be to allay this irritability. This is 
best accomplished by the use of compound tincture of benzoin, which 
is placed in boiling hot water (1 ounce to the pint [32.0 : 500 cc,]), 
and the steam inhaled as it rises from a pitcher or as it passes out of 
the nozzle of a deep coffee-pot. A better apparatus, if it can be 
obtained, is a can or wide-mouthed bottle arranged with one long and 
one short tube like a Wolff bottle, the air being drawn into the larynx 
through the short tube. This inhalation should be resorted to six or 



574 DISEASES. 

eight times a day, but the patient must not leave the house if the air 
is cool, as the steam relaxes the parts involved and renders them the 
more susceptible to cold. Sometimes advantage is gained by adding 
to this inhalation 1 grain (0.05) of menthol. If the patient is unable 
to remain in an equable temperature, then the steam-inhaler should 
be supplanted by the use by the physician of an atomizer throwing a 
fine spray, and in this atomizer should be placed a mixture as follows: 

R.— Menthol gr. iij (0.15). 

Albolene f£j (32.0).— M. 

S. — Use as a spray. 

The patient is directed to gently inhale this spray. 

Rarely in the very acute stages of laryngitis should the physician 
employ a watery spray to wash the laryngeal mucous membrane, as it 
is apt to increase the irritation. If any spray is used, as may be 
necessary when the irritation has resulted from the inhalation of dust, 
it may be made up as follows : 

R. — Sodii chlorid gr. xv (1.0). 

Acid, boric gr. x (0.65). 

Sodii borat gr. x (0.65). 

Aqua? rosa? f^iij (96.0). — M. 

S. — Use as a spray. 

The external treatment, if the inflammation is exceedingly severe 
and the patient can be confined to bed, is a mustard plaster or hot 
application over the larynx, care being taken that the volatile mus- 
tard does not render the air irritating to the larynx. A mustard foot- 
bath and a warm drink on going to bed are useful. 

The internal treatment should consist in opening the bowels with 
calomel and a saline purgative if constipation is present, and in the 
administration of full doses of aconite and bromide of sodium or 
potassium, as follows : 

R. — Tine, aconiti ^xij vel xxiv (1.0-1.6). 

Sodii bromid '. . gij (8.0). 

Syr. lactucarii (Aubergier) .... fjj (32.0). 

Aqua? q. s. ad fjiij (96.0).— M. 

S. — Dessertspoonful (8.0) every four hours. 

Or, 

R .— Potas. bromid ^iv (16.0). 

Tine, aconiti , . TT^xij (1.0). — M. 

Ft. in chart. No. xii. 
S. — One powder every four hours in water. 

This prescription may in many cases be continued until convalescence, 
as it stops cough, quiets the inflamed area, and allays arterial excite- 
ment. Often it is best to omit the aconite after the first few days. 
By the second day the patient should be directed to paint a heavy 
application of tincture of iodine over the larynx and episternal notch, 
as high as is possible without showing above the collar. In children 
and in some adults this is well substituted by oil of amber and sweet 
oil in the proportion of 1 to 3 parts rubbed on the chest. 



LEUCORBHCEA. 575 

For the stiffness following the inflammation preparations of coca 
are very useful, given internally, and tonics to the general system 
are needed. 

LEUCORRHCEA. 

This is a condition — vulgarly known as the " whites " — consisting 
in a hypersecretion from those glands which pour out their contents 
into the vagina or the cervical canal of the uterus, or even into the 
cavity of this organ. 

It is a state dependent upon many causes for its existence, the 
chief of which is a condition of the system when it is "run down" 
from any cause, with perverted functions of the glands or their sur- 
roundings. In some persons, who seem perfectly strong and well it 
would appear to be due to an effort of the system to overcome plethora. 
The character of the discharge varies with almost every case. In 
some instances it is thick and tenacious, in others so liquid as to 
trickle down the limbs in a stream and greatly soil the clothing. In 
most of the latter cases catarrh of the Fallopian tubes or ovarian irri- 
tation and tenderness will be present. Where the secretion is very 
thick and tenacious it generally arises from the cervical canal, while 
that from disorder of the vaginal wall alone, independent of other 
morbid conditions, may be either thick or thin. 

The treatment of these forms of leucorrhoea may be divided into 
two parts — one, that directed to the remedying of the morbid process 
through the use of drugs by the mouth; the other, by their employ- 
ment locally. 

It is needless to state that in that form dependent upon excessive 
lactation or other exhausting manner of life tonics of an active cha- 
racter are needed. As a general rule, anaemia will be present, and 
the following pill will be found of service : 

R. — Acid, arsenosi . gr. \ (0.016). 

Ferri redacti gr. v (0.25). 

Quininae suiph §j (1.3). — M. 

Ft. in pil. No. xx. 
S. — One pill three times a day, after meals, for an adult. 

Or, 

R.—Tr. ferri chloridi S5j.(4.0). 

Tr. cinchona? comp f.^ij (64.0). 

Tr. gentian, comp q. s. ad f^iv (128.0).— M. 

S. — Dessertspoonful (8.0) three times a day, after meals. 1 

Sometimes small doses of the sulphate of iron are better for this 
purpose, owing to its astringent properties, but when any prepara- 
tions of iron are used care must be taken that the bowels are kept 
active and that the stomach is not disordered. Associated with the 
use of these internal remedies should be a moderate amount of exer- 
cise and the avoidance of late hours and rich foods. 

1 In both these prescriptions the small amount of iron and arsenic given will prob- 
ably be noted, but this is done advisedly, as iron and arsenic do as much good to the 
blood in small as in large amounts under most circumstances. (See Iron.) 



576 DISEASES. 

The local applications which are of value in these states consist in 
counter-irritation and vaginal injections or painting the mucous mem- 
brane of the parts from which the discharge comes with proper fluids. 
In the leucorrhoea dependent upon irritation of the ovaries with 
catarrh of the Fallopian tubes the use of small blisters formed by 
the employment of cantharidal collodion or a cantharidal plaster over 
the groin on either side is often accompanied by good results. At 
the same time the vaginal surfaces surrounding the cervix uteri may 
be painted with a mixture of iodine, carbolic acid, and chloral, such 
as is used by Dr. Goodell, as follows : 

R. — lodi resublimat giv (16.0). 

Acid, carbol. crystal.") -- z . /o n\ 

Chloralis }....«& (32.0). 

Kub the iodine and chloral in a glass mortar into a powder and add the 
carbolic acid. 
S. — Formula. To be used by the physician only. 

The following pill may also be employed : 

R. — Hydrarg. chlor. corros gr. \ (0.03). 

Ft. in pil. No. xx. 
S. — One pill three times a day, after meals or a tablet triturate may be used instead of 
a pill. 

The remaining treatment of watery leucorrhoea consists in the use 
of astringent injections. A very cheap astringent injection is made 
by adding 1 ounce (32.0) of powdered white-oak bark to each pint 
(500 cc.) of water, or tannic acid and glycerin in the proportion of 1 
ounce to 2 quarts (32.0 : 2 litres) of warm water. Ringer recom- 
mends the following : 

R. — Sodii bicarbonatis 3j (4.0). 

Tincturse belladonna? f^ij (8.0). 

Aquse Oj (500 cc.).— M. 

S. — Use as a vaginal wash. 

Where the discharge is foetid a solution of permanganate of potas- 
sium should be used as an injection in the strength of J drachm to 1 
pint (2.0 : 500 cc.) of water. In purulent vaginitis, specific or other- 
wise, the following injection is serviceable: 

R.— Creolin fgss vel f£ij (2.0-8.0). 

Ext. hydrast. canaden. fl foijss (10.0). 

Aquse > f|viij (256.0).— M. 

S. — Add 2 tablespoonfuls to a pint (32.0 : 500 cc.) of hot water, and use as an 
injection. 

Sometimes a tampon thoroughly saturated with a powder of iodo- 
form and tannic acid, equal parts, and packed around a discharging 
uterine cervix, is of service. 

When using vaginal injections in females it is important to remem- 
ber that they should be in large quantities. Nothing is more antago- 
nistic to true asepsis than the usual manner in which these applica- 
tions are made. Generally a pint of the solution is placed in a basin 
over which the woman squats, and by means of a syringe forces the 



LUMBAGO. 577 

liquid into the vagina as fast as it runs out, thereby filling the syringe 
joints with the dissolved secretions, and returning to the vagina as 
soon as they flow away the impurities which have left it. The only 
proper way to give such an injection is to have the solution in one 
basin, to the extent of 1 gallon (4 litres), while the patient squats over 
a second basin, into which the impure liquid may run. 

A very useful astringent injection may be made by ordering 

R.— Zinc, sulphat f£j (4.0). 

Alumin. sulph f^j (4.0). 

Glycerini fjvj (192.0).— M. 

S. — A tablespoonful (16.0) to each quart (1 litre) of water. 



LID ABSCESSES. 

Lid abscesses are seen more frequently in children than adults, as 
the result of injury, the sequel of acute illness (epidemic influenza, 
pulmonary catarrhs, fever, etc.), or from local infection ; under the 
latter circumstance they may assume a gangrenous type. The treat- 
ment is that for any form of abscess — poultices, preferably in the form 
of hot compresses, early incisions, antiseptic solutions, and tonics. 



LUMBAGO. 

This is a form of myalgia or muscular rheumatism of the muscles 
of the loins and small of the back, and is frequently the result of 
lifting heavy weights or it results from other strains. In many cases 
acupuncture is very useful, particularly if the trouble is bilateral. 
Sometimes after the employment of this measure the patient can 
straighten the back at once and retain that position. In other 
instances antipyrine or acetanilid, in 10- to 20-grain (0.65-1.3) doses 
of the former and 4- to 8-grain (0.2-0.6) doses of the latter, are of 
service, and iodide of potassium and salicylic acid are not to be for- 
gotten if the condition of the patient does not rapidly improve. 
Phenacetin and salol are also useful, combined or alone. A large 
hot poultice applied to the back is often efficacious in obstinate cases. 
Sometimes a hot foot-bath and a Dover's powder on going to bed will 
produce a cure, and ironing the back with an ordinary hot laundry 
iron at a proper heat, a piece of newspaper or cloth being placed over 
the skin under the iron, is very efficient. Counter-irritation in the 
shape of a blister, a mustard plaster, or capsicum draft will often give 
relief. 

Where these measures fail the reverse treatment may be tried, such 
as an ice-bag placed over the loins or an ether spray turned on the 
part until the skin is greatly blanched. 



MALARIAL FEVER. 
(See Intermittent and Remittent Fevers.) 

37 



578 DISEASES. 

MANIA (ACUTE). 

Space is wanting to consider the thorough and complete treatment 
of mania as it comes to the neurologist. All that can be done here is 
to denote temporary measures suitable for cases which are brief in 
their course. 

In those cases which occur after confinement and are not supposed 
to be based upon permanent trouble, cimicifuga racemosa is said to 
be very useful in the dose of 20 to 30 drops (1.3-2.0) of the fluid 
extract three times a day, while for the rapid quieting of the patient 
we may use hyoscine hydrobromate in the dose of y^- grain (0.0006). 
In other instances, if the kidneys and heart are healthy, full doses 
of chloral may be used, and if an active preparation of cannabis indica 
can be had, at least 1 grain (0.05) of the solid extract or J to 1 drachm 
(2.0-4.0) of the tincture should be employed. Cannabis indica will be 
found particularly serviceable if 60 grains (4.0) of one of the bromides 
can be combined with it. 

Where a patient suffering from mania is so violent that nothing 
can be clone with him, he should be held, and an emetic dose of ^ 
grain (0.005) of apomorphine be given hypodermically to produce vom- 
iting and so relax the muscular system, or he may be tied or anaesthet- 
ized sufficiently to enable the physician to administer proper remedies. 
Sometimes full doses of morphine are needful, and in others a cold 
douche to the head while the bodv is in hot water is of service. 



MELANCHOLIA. 

This is not the place for the discussion of melancholia of so severe 
a form as to amount to insanity, since the treatment of this latter state 
is very various and largely depends upon the skill of trained physi- 
cians who are alienists. 

There is one form of melancholia, however, which may often be 
rapidly relieved by a simple measure. It is that dependent upon the 
condition of the system in which oxaluria is present. Whenever an 
individual complains of melancholia the urine should be examined, 
and if any oxalate crystals are found, undiluted, fresh nitromuriatic 
acid should be given in the dose of 5 drops (0.3) after each meal 
in a half- tumblerful or more of water. In order to guard against 
errors in diagnosis it is well to remember that pears, tomatoes, rhu- 
barb, and cabbage all cause oxalates to appear in the urine for a short 
period after their ingestion. 



MENINGITIS (ACUTE). 

Meningitis is to be treated as is any other form of acute inflamma- 
tion occurring in a sthenic or dynamic individual, and particularly 
does its treatment correspond to that of the other inflammations of 
large serous membranes, such as peritonitis or pleurisy. 

In the early stages the patient should receive sufficiently large 



MENINGITIS. 579 

doses of aconite or veratrum viride to strongly impress the circulatory 
system. These drugs have the power of producing such dilatation of 
the blood-paths throughout the body that the congested or inflamed 
area is relieved of its excess of blood, because, the pressure being- 
less elsewhere, the blood obeys the law that liquids always try to 
escape from pressure, and so leaves the meninges of the brain for 
the vessels of the limbs and trunk. A good-sized blister should 
always be placed at the nape of the neck as a counter-irritant to 
prevent effusion. 

The proper dose of veratrum viride in the form of the tincture is 
3 drops (0.15) every hour until the skin becomes moist or nausea is 
developed. 1 The tincture of aconite is also useful in full dose. If 
great arterial excitement is present, venesection may be practised 
(see Bleeding), but veratrum viride and aconite are better remedies if 
they are at hand. Associated with these tw T o drugs we should em- 
ploy mercury and opium, the first for its antiphlogistic influence, the 
second for its power in allaying irritation. J grain (0.016) of pow- 
dered opium and J grain (0.03) of calomel may be given every hour 
until the full effect of the opium or mercury is manifested. In some 
instances the deodorized tincture of opium (Tinctura opii deodorati) 
is better than the crude drug, in the dose of 2 to 5 drops (0.1-0.25) 
every one or two hours. Sometimes belladonna is of great service, 
and this is particularly the case where the drugs already named are 
contraindicated because of a condition of weakness or asthenia. In 
both conditions ergot is of value in allaying the congestion, but its 
period for exerting a favorable effect is not at the very first part of 
the attack, but a little later, when the stage of exudation is at hand. 

During the first acute stage an ice-bag should be applied to the 
head, both for its local influence and its antipyretic effect, and leeches 
may be put at the nape of the neck with advantage. As the disease 
advances and the nervous disorders of the affection become marked, 
nervous sedatives are required to allay the twitchings, muscular 
spasms, or convulsions, and for this purpose no drugs are to be com- 
pared to chloral and the bromides. The doses to be used vary with 
the violence of the symptoms, but it may be stated that the chloral 
should rarely, if ever, be used in doses above 10 grains (0.65), and 
the bromides given in the dose of from 5 to 40 grains (0.3-2.65). 
If coma comes on, a large blister should be applied to the nape of 
the neck. 

Quinine has been recommended in meningitis, but it is absolutely 
contraindicated, as it predisposes to this condition. It may be em- 
ployed only in convalescence, and then used most carefully. 

The treatment of the second stage of meningitis must be neces- 
sarilv supportive, owing to the reaction consequent upon great ner- 
vous and arterial excitement. Under these circumstances the use of 
opium is still indicated, because it allays nervous unrest and supports 
the system, partly by conserving the tissues and partly by inhibiting 

1 It is to be remembered that veratrum viride often causes nausea, and even vomit- 
ing, in susceptible persons, and in consequence it should be carefully given in menin- 
gitis, lest if vomiting come on the disease be made worse. 



580 DISEASES. 

the waste of nervous force apt to occur at this time. Alcohol should 
be given with the food if weakness is present, and a very simple 
milk diet insisted upon. 



MIGRAINE. 

(See Neuralgia.) 

MUSCLE VOLITANTES. 

Muscae volitantes is the name applied to the dark specks which 
pa ients frequently see floating across their fields of vision, especially 
if the eyes are directed toward a bright sky or a white page. Usually 
they indicate no disease of the vitreous humor, and the ophthalmo- 
scope fails to detect abnormal changes. They are attributed to tor- 
pidity of the liver by the laity. Muscae volitantes may indicate eye- 
strain, and if the refraction is abnormal this should be corrected ; a 
mild course of alteratives is often a useful adjuvant. 

MYALGIA. 

Soreness of the muscles either on pressure or on movement may 
be dependent upon a number of causes, such as strains, bruises, rheu- 
matic taint, or inflammation due to cold. Here, as in many other 
states, the treatment is to be divided into the external and the inter- 
nal methods. Of the internal remedies, the best are the salicylates 
or the iodide of potassium if rheumatism be at the base of the trouble. 
On the other hand, if a bruise or cold be the cause the chloride of 
ammonium will be of service in 10- or 20-grain (0.65-1.3) doses 
given in a solution with extract of liquorice. (For prescription see 
Bronchitis,) Other remedies which may be tried with a good chance 
of success are full doses of a good fluid extract of cimicifuga (20 
drops to 1 drachm [1.3-4.0]) or the citrate or acetate of potassium in 
20-grain (1.3) doses. 

The local medications are numerous, but only a few can be consid- 
ered as worthy of routine employment. The chief one is iodine, in 
the form of the pure ointment or diluted one-half with lard if the 
skin is easily irritated. Another method is to employ a liniment, well 
rubbed into the skin, made up as follows : 

R.— Tr. belladonna? f£j (4.0). 

Tr. aconiti f^ij (8.0). 

Tr. opii . . , f^ij (8.0). 

Liniment, saponis q. s. ad f^vj (192.0). — M. 

S. — Poison. To be used externally and only as a liniment. 

Sometimes chloroform liniment is singularly successful, and poul- 
tices applied as hot as can be borne and covered by oil-silk and cotton 
to retain the heat are often of great value. Massage or good rubbing 
is also a sine qua non for the successful treatment of this state. 



NASAL CATARRH. ■ 581 

NASAL CATARRH (ATROPHIC). 

Synonym, Atrophic Rhinitis. — The atrophic or last stage of nasal 
catarrh, commonly known as dry catarrh, is a natural sequence of 
the stage of hypertrophy, although in exceptional instances the 
atrophic type has appeared at once. Increased vascularity and over- 
stimulation of the hypertrophic stage lead to increased functional 
activity, and finally to exhaustion and atrophy of the tissues involved. 

In atrophic nasal catarrh the nostrils are roomy and the mucous 
membrane red and shiny. The formation of connective tissue has, 
to a great degree, obliterated the delicate serous glands, and the dis- 
charge of mucus, no longer diluted, forms inspissated crusts, which 
adhere to the mucous membrane of the septum and turbinated 
bones. 

Areas of ulcerated or abraded membrane are disclosed upon 
removal of these adherent crusts. 

The turbinated bones are gradually absorbed and the secreting 
surface thereby much reduced. Sometimes the wasting is so great 
that the posterior wall of the pharynx is clearly visible from the 
front. The inspissated secretion may make a cast of the nostril, and 
as fresh layers form underneath the oldest part is raised until the 
whole interior of the nostril becomes a mass of decomposition, giving 
rise to an overpowering stench. This form of catarrh causes loss of 
the sense of smell, and the odor is not recognized by the patient him- 
self. Ulceration or caries of the bony structure produces an odor 
even worse than the so-called ozosna. The pharynx suffers from the 
general wasting, and presents a dry, varnished appearance called 
pharyngitis sicca, which is rather a symptom of nasal atrophy than 
a separate disease of the pharynx. 

The indications are the removal of all accumulations in the nose 
and naso-pharynx and the healing of abraded or ulcerated surfaces. 
The early removal of dead bone is imperative, and what secreting 
surface remains must be stimulated as far as possible, to compensate, 
in a measure, for the glands that are hopelessly destroyed. In other 
words, our efforts are directed toward producing a compensatory hyper- 
trophy of the glandular tissue that remains. Therefore with the use 
of antisepsis we combine alteratives and local stimulation. 

The nose should be thoroughly cleansed with an alkaline wash — 
Dobell's solution — warmed to increase its solvent power. To relieve 
the odor increase the amount of carbolic acid or substitute for it 
eucalyptol and thymol in the wash. Listerine contains both of these, 
and may be added to the wash. Its own pungent odor masks some- 
what the offensive odor. • Permanganate of potassium may be used in 
weak solutions, but it is painful except when sensation is entirely lost. 
Peroxide of hydrogen is recommended, but the writer has had no 
experience in using it over such an extensive surface. 

The solutions are best applied by means of an atomizer or post- 
nasal syringe in the hands of the physician or by snuffing from the 
hand or cup. 

The odor, if due to decomposition, is much decreased as soon as 



582 DISEASES. 

the passages are clear. The discharge must never be allowed to 
reaccuruulate or much time will be lost. 

Ulcerations require local stimulation by a strong solution of nitrate 
of silver or a superficial application of the flat surface of the galvano- 
cautery heated to a dull redness. Necrosed bone should be removed, 
and it is often found detached in the nostril. 

Local stimulants should be judiciously combined with alteratives. 
Powders of nitrate of silver in starch, varying in strength from 1 to 
10 grains to 2 J drachms (0.65-10.0) of the latter, may be blown 
into the nostrils by means of an insufflator. Cover gently the whole 
surface with a thin layer, and use it only of sufficient strength to be 
slightly felt. Nitrate of silver, in solution, 1 to 10 grains to 1 fluid- 
ounce (0.05-0.65 : 32.0), gives better results at other times when 
applied to the mucous membrane. Avoid over-stimulating, and so 
exhausting, the glands which it is wished to strengthen. The use of 
alteratives may alternate with the silver salt and iodide of potassium, 
and this may be done by using solutions of iodine and glycerin, as 
recommended for hypertrophic nasal catarrh. Internally, the physi- 
cian should employ iodide of potassium to increase nasal secretions 
and mucous-membrane stimulants and tonics. He should also pay 
attention to the activity of the skin. 



NASAL CATARRH (CHRONIC). 

Chronic nasal catarrh is essentially a disease of civilization, which 
may occur at any period of life, but more commonly develops from 
youth to early adult life. 

Although more prevalent among the upper classes, it is in the 
lower ranks that it most frequently reaches its later stages and its 
worst forms. This does not result from lack of opportunity for treat- 
ment, but from the ignorance or indifference which this class show to 
diseases while there is no suffering and no interference Avith business. 

Continued exposure to the action of irritants of various characters 
in the form of dust or particles floating in the air keeps the mucous 
membranes in a state of constant irritation. A low grade of inflam- 
mation is established, resulting in permanent thickening of the 
mucous membrane and of the submucous connective tissue, with 
dilatation or actual hypertrophy of the erectile tissue covering the 
turbinated bones. The swollen tissues obstruct the passage of air 
through the nostrils, and mouth-breathing results, with its train of 
symptoms. 

The most common cause of catarrh is found in repeated attacks of 
coryza, each attack increasing the thickening of the mucous mem- 
branes and narrowing the breathing-space. 

Nasal catarrh in its course passes through three stages or periods — 
namely, the stage of coryza or acute nasal catarrh, and the chronic 
stages, known as hypertrophic and atrophic nasal catarrh. 

Coryza, or cold in the head, is not strictly a stage of nasal ca- 
tarrh, but, as stated elsewhere, is an acute inflammation of the nasal 



NASAL CATARRH. 583 

mucous membranes, generally running a definite course and termi- 
nating in recovery in a week or ten days. Its chief clinical import- 
ance, however, is derived from its tendency, when the vitality is 
reduced or recovery is retarded, to pass into a chronic stage, which, 
to all intents, is identical with the hypertrophic stage of nasal catarrh. 
The line of demarkation is not clearly drawn between these two dis- 
eases or stages, nor can we locate with absolute certainty the point 
where acute coryza becomes hypertrophic nasal catarrh. 

Atrophic nasal catarrh commonly develops from the hypertrophic 
stage, although occasionally the disease takes this form from the 
beginning. Its symptoms are essentially different from the other 
stages, being characterized by functional inactivity and derangement 
in place of the over-stimulation of the hypertrophic stage. 

Hypertrophic nasal catarrh commonly has its origin in a neglected 
cold in the head or in a series of colds occurring in rapid succession, 
keeping the nose in a congested state until the erectile tissue covering 
the turbinated bones loses in a measure its power of contracting, and, 
decreasing the calibre of the nostrils, becomes a source of permanent 
obstruction to breathing. 

As the disease increases there is increased susceptibility to cold. 
Slight exposure produces a stuffy feeling in the nose. The nostrils 
may become completely occluded ; usually, however, only one side 
at a time is obstructed at first, the obstruction showing a tendency 
to change sides. This change is most noticeable in turning in bed, 
the lower side usually stopping, and on changing the position the 
obstruction is reversed, the clearing being accompanied by a crack- 
ling sensation. A slight tickling cough and tendency to clear the 
throat in the mornings may result from irritation of the pharynx or 
larynx. 

The na&al obstruction, generally greatest at night, causes restless, 
troubled sleep, while the mouth-breathing leaves the tongue dry and 
coated in the morning. A dull, frontal headache, due to reflex irri- 
tation from intranasal pressure, is not uncommon. Unusual irrita- 
bility of the mucous membranes may result in frequent attacks of 
sneezing or in a free watery secretion, which is more active in cold 
weather, appearing as a drop of water, resembling a, bead, at the end 
of the nostril, which may drip from the nose on leaning forward. 

In patients of a neurotic type attacks resembling acute coryza 
occur without a moment's warning, and subside as quickly as they 
come. The nose at such times becomes stopped up to an oppressive 
degree, with free secretion, with or without violent sneezing. 

Such attacks are precipitated by exposure to a close or impure 
atmosphere or to dampness, especially at dusk when the dew is fall- 
ing, or when the patient is fatigued. The voice becomes husky or 
altered in character from loss of nasal resonance. Catarrh of the 
middle ear is liable to occur. 

During the early stage of hypertrophic rhinitis, on inspection of 
the anterior nasal passages all the tissues appear red and highly vas- 
cular. Along the surface and margin of the lower, and perhaps the 
middle, turbinated bones the tissues are swollen and puffy, and in 



584 DISEASES. 

severe cases these puffy bags adapt themselves to the shape of the 
nostril, completely closing the passage-way. They very rarely com- 
pletely close both sides, except during an acute attack of coryza. 
One or the other side, as a rule, remains open, with a tendency for 
the obstruction to reverse sides. The nervous impression produced 
by examination may cause temporary contraction and clearing of 
both sides, which, unfortunately, are soon as bad as ever. 

The swellings, as described elsewhere, consist of cavernous blood- 
vessel tissue, which has the property of filling with blood and erect- 
ing under stimulus. These swellings on the turbinated bones are 
known as hypertrophies, although at this stage they contain little 
hypertrophied tissue, but are, more strictly, bags of erectile tissue 
which have lost the power of contracting. They readily disappear 
upon pressure by means of a probe, but return at once when the 
pressure is withdrawn. Applications of cocaine (4 per cent, solution) 
produce some contraction, benumbing and blanching the tissues at 
the same time. 

The power cocaine possesses of contracting hypertrophied tissue 
is useful for purposes of diagnosis in hypertrophic nasal catarrh. By 
its use we may readily distinguish tumors or bony or cartilaginous 
growths from the erectile tissue. 

The long continuation of a low grade of inflammation favors the 
formation of connective tissue and actual hypertrophy of the turbi- 
nated tissues, which become larger and firmer, and do not completely 
disappear under pressure from a probe. At the same time a progress- 
ive increase in the nasal obstruction is observed. 

A rhinoscopic view posteriorly reveals a similar state of affairs, 
and a hypertrophy developing on the middle or lower turbinated bone, 
rarely on the upper. At this position the hypertrophy appears as a 
round, globular tumor extending backward toward the vault of the 
pharynx. It is sometimes sessile, but often has a slight constriction 
at its attachment to the turbinated bone. It is occasionally pale and 
covered with mucus — indeed, a collection of mucus may be mistaken 
for an hypertrophy. Cleansing the nose with a solution sprayed by 
means of an atomizer directed through the nose from the front, or by 
a post-nasal syringe from behind, clears the diagnosis. 

At other times a posterior hypertrophy becomes engorged with 
blood and presents a deep purple color, resembling in size and shape 
a red raspberry. 

Enlarged pharyngeal tonsils produce decided obstruction poste- 
riorly, and, by the secretion of large quantities of mucus cause a 
constant feeling of fulness, with a desire to "hawk " and spit. 

An enlarged pharyngeal tonsil is recognized as a soft, spongy mass 
in the vault of the pharynx. Occasionally it hangs down in festoons 
which somewhat resemble stalactites hanging from the roof of a cave. 
Should one of these stalactites become eroded, it may cause frequent 
and alarming hemorrhages. 

Hypertrophy of the pharyngeal tonsil is more common in children 
than in adults, and frequently occurs in connection with hypertro- 



NASAL CATARRH. 585 

phied faucial tonsils or in conjunction with adenitis, or results from 
diphtheria or scarlet fever or as part of a strumous diathesis. 

Hypertrophied tonsil is a fruitful source of deafness in children, 
as it may become large enough to interfere with the passage of air 
through the Eustachian tube or cause extension of catarrh to the 
middle ear. 

When a child is too small to permit a rhinoscopic examination, the 
presence of an enlarged pharyngeal tonsil may be felt by introducing 
the index finger through the mouth up behind the soft palate, taking 
care that the finger is protected from the child's sharp teeth. 

It is well to educate the finger to recognize the size and shape of 
the naso-pharynx, although its introduction is a disagreeable per- 
formance, for it may aid materially in outlining the structure, con- 
sistency, or point of attachment of tumors projecting from the nose 
into this space, or even assist in engaging a large growth in the loop 
of wire from a snare introduced through the nose. The ear should 
be educated to recognize the different effects produced on the voice 
by obstructions in the front or back of the nose and to assist the eye 
in diagnosis. 

Occlusion of the nostrils, if well in front, gives a nasal sound to 
the voice from the pent-up vibrations in the nose and naso-pharynx. 
An obstruction at the back of the nose deadens the voice, interferes 
with its carrying power, and prevents the voice being heard at any 
distance from the speaker. The voice, to use a technical term, loses 
its timbre, and should it be used to any extent chronic laryngitis 
results. The extra pressure injures the larynx and tires the throat, 
Avithout increasing the carrying power. 

The pathological changes occurring in hypertrophic nasal catarrh 
do not differ materially from similar changes occurring in catarrhal 
inflammations elsewhere. In treating catarrh find the cause, and, if 
possible, remove it. Great assistance in this direction may follow 
careful inquiry into the occupation and environment of the patient. 

The difference between nasal catarrh and simple catarrh occurring 
in other places is chiefly the result of location. The nasal mucous 
membranes are surrounded by bony walls which limit the power of 
swelling to one direction — namely, toward the centre. This affects 
the main function of the nose, that of respiration, and obstructed 
respiration leads at once to a train of symptoms, not of catarrh, but 
of the results of catarrh. 

Swelling of the turbinated tissue and nasal obstruction are early 
symptoms of hypertrophic nasal catarrh. The change in functional 
activity which is caused by obstruction to respiration, and the nervous 
irritation resulting from pressure, sooner or later produce permanent 
injury, either local or reflex. 

The first indications for treatweyit are the reduction of inflamma- 
tion and restoration of the breathing-space. 

As the chief function of the nose is respiratory, the re-establish- 
ment of free nasal respiration, combined with the liberal use of anti- 
septic washes, will lessen the inflammation and irritation and produce 
a healthier state of the secretions. 



586 DISEASES. 

The writer places cleanliness at the head of the list of remedial 
measures. The alkaline wash recommended on page 472, sprayed 
into the nose by a hand atomizer or gently snuffed from the palm of 
the hand or from a small cup, gives good results. The hand warms 
the solution slightly, but when snuffed from a cup the solution should 
be artificially warmed. This wash may be used two or more times 
a day. 

The nasal douche should never be used where there is nasal ob- 
struction, on account of the risk of forcing the solution into the 
Eustachian tube and causing catarrh of the middle ear. 

In addition to the antiseptic wash where the mucous membrane is 
congested and irritable, the treatment recommended for coryza may 
be instituted for a few days with good results. A solution composed 
of equal parts of distilled extract of hamamelis and water or a dilute 
solution of hydras tis may be sprayed into the nose during the acute 
stage. 

A little later a spray of ferric alum, 5 grains to the ounce (0.3 : 
32.0), may be applied carefully in an atomizer by the physician. 

It is not advisable to use alum in any considerable strength in the 
nose, as its continued use is liable to impair the sense of smell. 

The alterative and absorbent action of iodine makes it a valuable 
remedy for local application in chronic nasal catarrh. Combine it 
with glycerin in the strength of 6 or 8 grains to the ounce (0.35 : 
32.0), with enough potassium iodide to make a solution. Apply this 
by means of a piece of absorbent cotton on the end of an applicator, 
along the floor of the nose, until it reaches the pharynx. It is need- 
less to say that such an application as this should be made with the 
utmost gentleness. The cotton should project beyond the probe, and 
care should be taken to avoid bruising the tissues. 

After the acute stage has subsided, as shown by the disappearance 
of the livid color and lessened sensibility, any remaining hypertro- 
phied tissue should be removed by a snare or the galvano-cautery. 

NEURALGIA. 

Like headache, neuralgia gives rise to most of the suffering expe- 
rienced by active persons who are not sick enough for bed and by 
those who are confined to bed by other diseases. It affects members 
of every walk of life, and may be so severe as entirely to incapacitate 
the most powerful of men. 

The causes of neuralgia are very various, but they may be briefly 
stated to depend chiefly upon malnutrition, over-work, nervous excite- 
ment with consequent reaction, and to reflex irritation from diseased 
organs, as in the case of supraorbital neuralgia from eye-strain or 
ovarian irritation from uterine inflammation. Nerves functionally 
diseased are always more or less active than normal ; that is, hyper- 
excited or A?//?o-excited, above or below par. In both cases they 
must be brought back to their normal tone by appropriate remedies, 
and these consist in nervous excitants and nervous sedatives. To 
give a nerve already depressed the additional depression of a bromide, 



NEURALGIA. 587 

or a nerve excited the additional excitement of strychnine, would be 
absurd. 

From what has just been said it becomes evident that the physician 
must always determine the condition of the system of his patient and 
the causes of that condition before administering remedies. 

The treatment of this disease from its curative standpoint may be 
divided into the use of tonics, nutritives, and palliatives. 

Where neuralgia is associated with anaemia no hope of permanent 
relief can be looked for unless iron and arsenic are used until the 
anaemia is cured, and it is often necessary to combine with these 
drugs the use of cod-liver oil and bitter tonics. These are the cases, 
too, in which nux vomica and strychnine raise the depressed nerves 
to increased activity, and so bring relief. How they do this is not 
known, but we know enough to recognize one or two important facts. 
Strychnine is certainly a nervous stimulant, and is also a stimulant 
to the anterior columns of the spinal cord. It probably also acts 
upon the trophic centres in the anterior cornua of the spinal cord, 
and by stimulating these centres increases the nutrition of the trib- 
utary nerve-fibres. 

It is needless to state that the neuralgias of syphilis and scrofulosis 
are to be treated by the specific remedies directed to the cure of these 
affections, while at the same time the various symptoms are carefully 
controlled by appropriate palliatives. 

When nervous exhaustion causes neuralgia, phosphorus is a useful 
remedy, particularly in those cases which are convalescing from acute 
fevers. 

Sometimes malarial poisoning produces a violent form of supra- 
orbital pain known as "brow ague," which is to be relieved, not by 
ordinary remedies, but by large doses of quinine. 

The relief of the states producing neuralgia having been spoken 
of, it yet remains for us to consider the measures to be adopted for 
the cure of an attack. Fortunately, the recent advances of thera- 
peutic study have placed in our hands a large list of drugs not apt to 
produce a habit after prolonged use, comparatively safe though active, 
and not of disagreeable taste or evil general effect. By these terms 
the writer refers to antipyrine, acetanilid, and phenacetin, all of 
which possess wonderful power in the alleviation of pain dependent 
upon true nervous involvement. In order to avoid failure in the use 
of these drugs in the relief of headache, we must always remember 
that their field of service is that of neuralgic pain, not other pains. 
Antipyrine is to be used in the dose of 5 to 20 grains (0.3-1.3) for 
ordinary neuralgia or the pain arising from the crisis of locomotor 
ataxia, acetanilid in the dose of 3 to 8 grains (0.18—0.5) for the same 
purposes, and phenacetin in the same amount as acetanilid. 

Upon these remedies, combined with caffeine and the bromides 
according to circumstances, we now depend, and the following pre- 
scriptions will be found of service : 

R — Antipyrini £j vel ^ij (4.0-8.0). 

Caffeina? citratis gr. xx (1.3). — M. 

Ft. in chart Xo. x. 
S. — One every thirty minutes till relieved. 



588 DISEASES. 

The following may be of use also : 

K— Antipyrini 3J vel 317 (4.0-8.0). 

Potassii bromidi 3iij (12.0). — M. 

Ft. in chart No. x. 
S. — One every thirty minutes till relieved. 

Or, when the caffeine in the first prescription causes nervousness, 

R— Antipyrini £j vel £ij (4.0-8.0). 

Cafteinse citratis . . , gr. x (0.65). 

Potassii bromidi 3iij (12.0).— M. 

Ft. in chart No. x. 
S. — One as above. 

In any one of these prescriptions acetanilid or phenacetin may be 
substituted for the antipyrine. 

A very effective remedy in some cases of neuralgia of the fifth 
nerve is croton chloral in from 5- to 20-grain (0.3-1.8) doses in pills 
of 5 grains (0.3) each. 

In some cases of anaemic neuralgia of the head nitrite-of-amyl 
inhalations have proved useful, by reason of the cephalic flushing pro- 
duced by this drug. 

A very large number of local applications have been used with 
success in obstinate neuralgias and other cases not so difficult of cure. 
Cocaine cannot be applied, as it does not penetrate the skin, but relief 
can sometimes be obtained by the local use of the oleate of aconitine 
painted over the spot if it be limited in area. Much of this alkaloid 
cannot be applied, lest poisoning by absorption occur. 

Where the nerve is very superficial it can often be treated by cold 
with great success This is accomplished by freezing the parts with 
an ether or a rhigolene spray or by the application of a small package 
of finely-chopped ice and salt. Within the last few years the treat- 
ment of neuralgia by kataphoresh (see Part III.) has come into prom- 
inence, and consists in the use of some local anaesthetic, such as chlo- 
roform, which is applied over the part on a small piece of lint, and a 
galvanic current used through the pledget, which is attached to the 
positive pole. Under these circumstances the anaesthetic passes 
through the skin and affects the nerve. 

A very useful local injection in localized neuralgia is \ to \ of a 
grain (0.016) of morphine, but the danger of beginning the morphine 
habit is to be remembered when treating chronic cases. Sometimes 
acupuncture (see Part III.) is of service, and the surgeon may be 
called upon to stretch the nerve or to do a neurectomy. 

There still remains to be considered a form of neuralgia generally 
known as migraine. This affection is very severe in its manifesta- 
tions, and is often most obstinate in yielding to treatment. Com- 
monly it is associated with eye-strain or cerebral disease or other sim- 
ilar cause, and these must be removed before a cure is entirely 
effected. The best treatment of most of these attacks is the use of 
20 drops (1.3) of the tincture of cannabis indica every hour if a good 
preparation can be had, or by the use of \ to \ grain (0.016-0.30) 
of the solid extract every two hours, accompanied by 10 to 20 drops 
(0.65-1.3) of tincture of gelsemium. (See article on Headache.) 



OBESITY. 589 

NIPPLES (SORB). 

Whenever the nipples become sore, so that it is impossible for the 
mother to allow the child to nurse, a solution of cocaine of the 
strength of 4 grains to the ounce (0.2 : 32.0) should be applied to the 
part, and washed off carefully just before the child sucks. Following 
the nursing, a solution of boric acid, of the strength of 20 grains to 
the ounce (1.3 : 32.0) of water or mucilage of acacia, may be used over 
the part, the nipple being thoroughly dried beforehand. Where the 
fissures are deep and slow to heal the tip of a stick of silver nitrate 
may be applied to them with advantage. Some practitioners employ 
tincture of benzoin over the inflamed part, and glycerite of tannin is 
often of value. Cleanliness, dryness, and care of the breast previous 
to parturition do much toward preventing the condition. 

Sometimes it is necessary to use a breast-pump or nipple-shield 
before a cure can be effected. 



OBESITY. 

Whenever an excess of fat accumulates in the body as part of its 
substance, various discomforts, both mental and physical, arise, and 
in addition the normal functions of all the parts are so disturbed or 
interfered with that the continuance of health is often impossible. 
In many cases the deposition of fat about the heart or between its 
fibres results in serious symptoms ; and breathlessness on exertion is 
produced by the obstruction which is offered to the free movements 
of the diaphragm by masses of omental fat, aided by the fact that 
the great weight and bulk of the body requires severe muscular effort. 
It is worthy of note, also, that a layer of fat over the body increases 
the vascular surface very greatly, and in consequence gives the heart 
the labor of supplying a larger number of blood-vessels. 

The causes of obesity are numerous. In many families there is an 
inherited tendency, while in others only certain individuals are affected. 
These persons are fat because their systems naturally tend to the de- 
posit of obese materials, in the same way that the members of one 
family have large bones, while those of another have small bones. 
The etiology of obesity, outside of the causes just named, are very 
numerous, but the chief one is over-indulgence in food. 

Just at this point it is not out of place to state exactly what over- 
indulgence in food means. Every individual is a law unto himself 
in regard to the amount of food which is consumed and ingested. 
One often sees large, powerful, wiry men, who eat little, sit beside 
others, not so powerful or large, who eat excessively, and who appa- 
rently do not suffer from indigestion in consequence. Neither of these 
two groups becomes excessively fat, because one represents a grate 
which burns its fuel so that there is no waste, while the other resem- 
bles a grate in which there is always a residue of unburnt coal, which 
is cast out with the ashes as effete matter. As different engines of 
the same build require varying amounts of coal, so do different men 



590 DISEASES. 

assimilate different amounts of food. No stated amount of food can 
be set down as a man's daily portion until his case is carefully 
studied, but it is important to remember that the quantity of food is 
generally in direct ratio to the severity of the toil, and that a man 
who loafs about a club or "takes life easily " often eats more than a 
day-laborer — of far richer foods, too — and wonders why he gets stout. 
In nearly every case of obesity not dependent upon gross disorder 
of the trophic nerves over-indulgence in food is the cause. To some 
this may seem absurd, and the patient will say that he eats just 
enough to keep him from feeling empty between meals ; but this does 
not alter the case in the least. The proper amount of food for a man 
is not what his appetite or gastric viscus calls for, but what his sys- 
tem needs. To this further reference will be made when considering 
the diet for obesity, found below. 

The very presence of fat aids in the deposition of it, for, by act- 
ing as a non-conducting pad all over the body, it prevents the dissi- 
pation of heat, and so decreases the combustion of those substances 
which, when not used for the manufacture of heat, are deposited as 
fat. Again, we nearly always find that obese persons take alcohol 
with their food, thereby increasing the fat in their bodies ; for, find- 
ing that they cannot digest all the substances which greediness makes 
them swallow, they take alcohol to stimulate their digestive apparatus 
to increased efforts and assimilation. Further than this, alcohol adds 
force to the body, and preserves the tissues by substituting itself for 
food in the oxidizing processes. 

We find, therefore, that three great causes are active in producing 
corpulence in many cases — namely, heredity, over-indulgence in food, 
and lack of exercise, which is one of the means by which over-indul- 
gence is produced; i. e. less exercise, less food needed, but often more 
eaten. 

The treatment of corpulence rests solely upon the conditions named. 
In all instances the diet is the important point for the bestowal of 
care. Reference has already been made to the fact that the needs of 
the system are the criterion by which we judge the amount of food 
necessary to each case, not the sensations in the stomach. The use of 
coca by the natives of South America enables them to withstand 
hunger and privation, not because it gives tissue to the body, but 
because it paralyzes the sensory nerves in the stomach and relieves 
the sensation of hollowness or weakness which we are accustomed to 
overcome in this country, in the absence of food, by tightening our 
belts. Every one who has undergone severe mental or physical labor 
and missed a regular meal will remember that about the usual hour 
for the meal his sensation of emptiness may amount to nausea and 
distress, but the hour once passed he feels as strong as before until 
by prolonged toil he so exhausts his poAvers that the s}^stem forces 
him to eat, not so much from hunger as from, exhaustion. To under- 
stand this clearly, we must recollect that the system keeps its shares 
of force in the same way as a careful speculator keeps his shares of 
stock — namely, one part in active use for speculation, the other half 
for reserve in case of need. In health the stomach begins to " feel 



OBESITY. 591 

hungry " as soon as the speculative shares of force are nearly used, 
in order to cause the ingestion of more food and to preserve the 
" sinking fund " intact. It becomes evident, therefore, that the mere 
presence of hunger is purely a symptom, not an indication of the 
absolute necessity of food, for, if it were, the consumptive would 
be notorious for his appetite, instead of being noteworthy for his 
anorexia. 

The food of the patient suffering from obesity is to be cut down 
gradually, and the character of it arranged so that, though its bulk 
be great, its nutritive properties are small. Beef and other meats 
are concentrated foods containing much nourishment in a small space, 
while lettuce, spinach, cabbage, and nearly all vegetables, except 
roots or tubers, contain a large amount of fibre useless to the body. 
By the use of a carefully arranged vegetable diet in obesity we cut 
down the actual amount of food absorbed, and by its bulk keep the 
stomach so busy at sifting the nutritious from the non-nutritious mate- 
rials that hunger is not felt, because another meal-time is reached 
almost before the food of the first is assimilated. We find, therefore, 
that the diet for the reduction of corpulence should consist chiefly 
of bulky vegetables, but not too exclusively of any one article or 
set of articles. Heretofore it has been thought that proteids (meats, 
eggs, etc.) should be used to take the place of all hydrocarbons or 
carbohydrates (fats, starches, and sugars), but this is not physio- 
logically correct, as both forms of food are always needed for health, 
and it has been found that proteids may be converted into fats in the 
body. 

The following bill of fare will be found of service in the treatment 
of obesity : 

Breakfast : One or two cups of coffee or tea, without milk or 
sugar, but sweetened with a fraction of a grain of saccharin. 3 
ounces of toasted or ordinary white bread or 6 ounces of bran bread. 
Enough butter may be used to make the bread palatable — not more 
than 1 ounce. Sliced raw tomatoes with vinegar or cooked tomatoes 
without any sugar or fats. This diet may be varied by the use of 
salt or fresh fish either at breakfast or at dinner. 

Noon meal (dinner) : One soup-plate of bouillon, consomme, St. 
Julien, or other thin soup, or Liebig's or Johnston's beef essence, fol- 
lowed by one piece of the white meat of any form of fowl or a small bird. 
Sometimes a small piece, the size of one's hand, of rare beef or mut- 
ton, but no fat, may be allowed, and this should be accompanied by 
string-beans, celery, stewed or raw, spinach, kale, cabbage, beans, 
asparagus, leeks, and young onions. Following this, lettuce with 
vinegar and a little olive oil (to make a French dressing), a cup of 
black coffee or one of tea, and a little acid fruit, such as some sour 
grapes, tamarinds, and sour oranges or lemons, may be taken, and 
followed by a cigar or cigarette. 

Supper should consist of one or two soft-boiled eggs, which may 
also be poached, but not fried, a few ounces of bran bread, some 
salad and fruit, and perhaps a glass or two of light, dry (not sweet) 
wine, if the patient is accustomed to its use. 



592 DISEASES. 

Before going to bed, to avoid discomfort from a sensation of hun- 
ger during the night, the patient may take a meal of panada or soak 
Graham or bran crackers or biscuits in water and flavor the mass 
with salt and pepper. 

The reduction of diet is generally best accomplished slowly, and 
should be accompanied by measures devoted to the utilization of the 
fat present for the support of the body. Thus the patient should not 
be too heavily clad, either day or night, should resort to exercise, 
daily becoming more severe, and should drink freely of water, pro- 
vided that sweating is established sufficiently freely to prevent the 
accumulation of the liquid in the vessels and tissues. 

Very often a cold bath will, by its dissipation of heat, cause 
destruction of fat, which will be burnt up in the body in the manu- 
facture of heat-units to maintain the temperature ; and if the patient 
is not too anaemic and stands this exposure to cold well, the bath 
should be repeated each day or a Turkish bath used instead. 

The bowels should be kept active by laxative fruits or purges, but 
if liquids taken in drink are not eliminated rapidly, saline purges are 
useful, since, if the blood-vessels are engorged, the circulation in the 
capillaries is slow and a deposit of fat is apt to result. 

Where proper exercise is impossible the rest cure, with massage, 
electricity, passive exertion, and an absolute skimmed-milk diet, may 
be resorted to, particularly in those persons known as "fat anaemics," 
who have not enough red corpuscles in their blood to carry sufficient 
oxygen to the tissues to complete oxidation. 



PERICARDITIS. 

Inflammation of the pericardial sac is a frequent occurrence and 
requires prompt treatment. If the case be sthenic and is seen early, 
five to ten leeches should be placed over the praecordiuru, and at the 
same time sufficiently large doses of veratrum viride or aconite resorted 
to to depress the circulation, and by the dilatation of the blood-vessels 
elsewhere to draw off the blood from the inflamed area. To prevent 
the outpouring of a plastic exudate capable of undergoing organiza- 
tion and forming adhesions, calomel should be given in J-grain (0.03) 
doses every hour, combined with enough opium to prevent purgation. 
An ice-bag placed over the praecordium not only relieves, quiets the 
circulation, and reduces the temperature, but also acts favorably in 
modifying the severity of the inflammation. 

Where the case passes from the acute stage of inflammation to that 
in which effusion takes place, the treatment changes at once, and 
becomes supportive if the system shows signs of failure. The fric- 
tion-sounds of the first stage are now lost, and the heart-sounds may 
be feeble or muffled in tone by reason of the effusion present. Digi- 
talis, alcohol, or caffeine may be used if the heart shows signs of fail- 
ure, but when digitalis is used its influence should be carefully watched, 
since the employment of this drug produces a very full diastole or 
dilatation of the ventricles, and these are already cramped for space 



PERITONITIS. 593 

in which to dilate by reason of the exudate which has entered the 
pericardial sac. If the effusion is sufficient to endanger life, it should 
be tapped and aspirated away very gradually. Often it is best to use 
a long needle attached to a hypodermic syringe in order to be sure 
that there is fluid. The best place for making the puncture is the 
fourth or fifth intercostal space, one inch to the left of the edge of 
the sternum. Should pus be present, free drainage must be gradually 
established. In other instances, if the patient is strong, it is only 
necessary to administer hydragogue purges, such as jalap (20 grains 
[1.3] of the compound jalap powder), or elaterium J grain (0.01), or 
a saline purgative in concentrated form, before breakfast. Often a 
blister over the praecordium is of service. 



PERITONITIS (ACUTE). 

The views of the best minds in the medical profession concerning 
the treatment of peritonitis have changed radically in the last ten 
years, chiefly through the advances made in abdominal surgery and 
bacteriological research. These opportunities for study have shown 
that peritonitis never arises as a strictly primary condition, but is 
due in every case to the infection of the peritoneum by micro-organ- 
isms, benign or malign, which are originally found in the intestines 
or other portions of the abdominal viscera. Even w T hen peritonitis 
follows directly upon injury, the actual cause of the pathological 
process is the escape of micro-organisms through the devitalized wall 
of the intestine, and the severity of the attacks depends in turn upon 
the vital resistance of the patient, the degree of infection, and the 
rapidity with which a plastic exudate is thrown out to encapsulate 
the inflamed area. 

It is not possible in this short article to discuss the facts now 
known in regard to the etiology and pathology of acute peritonitis. 
Suffice it to state, one of the germs found normally as a benign 
inhabitant of the intestine becomes at once, on entrance into the 
peritoneal cavity, malignant and capable of producing rapidly-fatal 
peritonitis. Nor is actual rupture of the bowel or appendix vermi- 
formis necessary for this infection, since it has been shown that this 
germ, the bacillus coli communis, rapidly migrates through the bowel- 
Avall as soon as it becomes inflamed or congested in all its coats. 
Streptococci and staphylococci, finding access to this cavity, also 
produce violent inflammation. It has been found that the perito- 
neum will destroy many infecting germs in the healthy man if its 
vitality is not impaired, but if it is impaired a mild infection starts up 
severe inflammation. 

Having learned, then, that acute peritonitis is always secondary to 
some local cause or to some general infection, the first thing for the 
therapeutist to do, being called in to a case of this disease, is to deter- 
mine what the provoking agent is, in order that his treatment may 
be directed against the cause rather than the effect. This cause is 
now known, in the great majority of cases, to be Appendicitis (which, 

38 



594 DISEASES. 

see), the inflammatory process being spread by infection from this 
source. In women it is not uncommonly due to more or less obscure 
pelvic disease, or, again, it may arise from abscess and other severe 
diseases of the liver, spleen, pancreas, or stomach. Finally, it should 
never be forgotten that intestinal obstruction is a frequent cause of 
peritonitis, The physician may rest assured that if he cannot find 
the provoking cause, it is his own fault, and not that the case is purely 
idiopathic. 

Having found the cause, treatment is of course to be at once insti- 
tuted, and is medical or surgical — more commonly the latter than the 
former, since nearly all the provoking causes of this disease are at 
most only palliated by medicinal treatment, while they can sometimes 
be removed by surgical interference. Fortunately for those who can 
only obtain medicinal treatment, nature does much to aid in produ- 
cing a cure in many cases by limiting the disease through its localiza- 
tion by walls of lymph, so that many cases of peritonitis recover with- 
out active medicinal or surgical care. In the pelvis this localization 
of the process is very apt to take place unless the infection follow 
childbirth, when septic diffuse peritonitis may arise, which is nearly 
always fatal. 

If the trouble arise in the appendix vermiformis, this condition 
may be treated in its early stages by the means suggested in the arti- 
cle on Appendicitis, but at the very first sign of the spread of the 
inflammation, or of its becoming locally very severe, or of general sys- 
temic disturbance, the surgeon must be called in. The difficulty is 
that in many cases requiring operation, the operation is performed too 
late through the hesitancy of the patient, his friends, the physician, 
or even of the operator himself. If the local trouble does not seem 
to be spreading and the patient's general condition is favorable, ope- 
ration should be postponed indefinitely or until a state of quiescence 
is reached, when the prospects of recovery from operative interference 
are better. If there is reason to believe that an abscess has ruptured 
into the peritoneal cavity, or if perforation of the bowel is followed 
by severe general symptoms of widespread peritoneal difficulty, ope- 
ration should be resorted to at once. 

In deciding the question, however, as to whether a case of periton- 
itis requires surgical interference, the physician at the present time 
is in an unfortunate position. There can be no doubt that there are 
many records in medicine which prove most conclusively that lives 
have been saved through operative interference which would have 
been undoubtedly lost had the surgeon not come to the rescue. On 
the other hand, there are cases in which a fatal result has followed 
an operation, and in which the physician has bitterly reproached him- 
self that he consented to surgical interference, for as he looks back 
over the case he perceives that the operation has distinctly aided in 
causing the loss of life. At the present time each case must be 
decided upon its individual merits, and the physician or surgeon in 
giving advice to the family in regard to a well-developed case of peri- 
tonitis should always be careful to let them understand distinctly that 
the condition of the patient is most alarming, and the chances of life 



PERITONITIS. 595 

poor whether the treatment be medical or surgical, since in many 
instances neither form of remedial measure can possibly produce good 
results. In other words, the relatives should clearly understand that 
whether medicinal measures or surgical procedures are resorted to, the 
patient has only a fighting chance. 

The following case illustrates the value of surgical interference in 
peritonitis : 

M was taken ill at twelve midnight, with violent pain in the 

belly, and was seen by the writer the following evening at eight 
o'clock. At this time all the physical signs of a widely-diffused 
peritonitis were present. The belly was hard and board-like, the 
puJse was exceedingly rapid, the respirations fifty-six, and there was 
great pain. Careful physical examination of the belly and a study 
of the patient's history failed to reveal any cause near or remote for 
the attack, he having been in perfect health up to the time at which 
the pain began. After consultation with an eminent surgeon it was 
decided that his condition was so pressing that death under medicinal 
treatment was assured, and that, while operative interference offered 
but a faint chance of success, it was the only measure which could be 
resorted to. Accordingly, at twelve o'clock that night, just twenty- 
four hours after the pain began, the patient was operated upon, the 
incision being made in the median line for the purpose of exploring 
the belly, with the hope that an exciting cause for the attack might 
be found. On opening the belly it was found that acute intestinal 
obstruction had taken place through the bowel being twisted over an 
old inflammatory band. After this obstruction had been reduced the 
appendix was examined, and found to be in a condition of acute in- 
flammation, and for this reason it was removed. It was noted that 
the peritoneal surfaces of the intestines and of the abdominal wall was 
intensely hypersemic and red and lacking in their normal appearance. 
The operation lasted an hour and a half, and the patient recovered 
after a desperate struggle for life which lasted for weeks, during 
which time his attendants several times gave up all hope of his re- 
covery. Had no operation been permitted, death would certainly have 
resulted from the intestinal obstruction if not from the appendicitis, and 
had the median incision not been made, but the appendix alone sought 
for by a lateral incision, the obstruction would have been overlooked, 
and the death recorded as one due to general peritonitis following 
appendicitis for which an operation had been performed unsuccessfully. 

On the other hand, the writer saAv a case in which the conditions 
before operation were apparently identical with that just named, in 
which appendicitis and obstruction Avere discovered at the operation, 
and in which death took place as early or earlier than it would have 
occurred had operative interference not been resorted to. These two 
cases are mentioned for the purpose of emphasizing the fact that a 
definite prognosis as to the results of treatment, either surgical or 
medicinal, in peritonitis is not possible. 

Aside from the surgical treatment, which is an absolute essential in 
many cases of peritonitis, we have at hand medicinal methods which 
are of some value early in the attack and Avhere operation is refused 



596 DISEASES. 

or considered inadvisable. The first of these is the use of opium, 
given until the pain is partly removed and the respirations decreased 
to twelve or fourteen per minute. The patient should never be 
so narcotized as to have no pain on abdominal palpation or be 
unable to answer questions. On the other hand, it should be 
remembered that cases of peritonitis bear large doses of opium 
without effect. The dose should be pushed till the desired effect 
is obtained, and not be measured in grains. Cases are on record 
in which many hundred grains of opium have been given in a few 
days, with recovery as a result. 

For many years physicians of repute have regarded mercury as the 
drug above all others capable of modifying inflammations of serous 
membranes, particularly if combined with opium. Half-grain doses 
of calomel may be used every hour for twenty-four hours. An ice- 
bag or a turpentine stupe may be put over the the area originating 
the trouble. If the case is very sthenic, leeches may be used on the 
belly, but this is not advisable in most cases, as the patient may later 
need the blood to preserve his strength. Should vomiting be a press- 
ing symptom, it is best controlled by the use of two grains of ace- 
tanilid every two or three hours with brandy and ice. Medication is 
best carried out by the hypodermic needle or the rectal injection. 
The thirst in many cases of peritonitis is excessive, and ought to be 
relieved by giving small pieces of ice with or without a little white 
of egg poured over it. Even small amounts of water are not to be 
forbidden, since the vomiting is reflex, and the water allows the vom- 
iting to take the place of the more exhausting retching. If collapse 
is threatened, the best remedy is probably the extract of hyoscyamus 
by the rectum in injection or suppository, since this drug, while it 
contracts the vessels and soothes the nervous system, does not tend 
to produce disagreeable symptoms as does belladonna. 

The question of the use of purgatives in cases of peritonitis has 
been much discussed. The writer believes that in cases of perito- 
nitis following operation, where the operator knows the intestine is 
intact, saline purgatives, such as teaspoonful doses of a saturated 
solution of magnesium sulphate every ten or fifteen minutes, may 
be used in many cases with good effects ; but if there is any pos- 
sibility of the peritonitis being caused by perforation or obstruc- 
tion, their use is absolutely contraindicated, since if used the con- 
tents of the gut may be washed into the peritoneal cavity or the 
obstruction be rendered more complete. The saline purgative not 
only empties the bowel, but in addition, by the free watery flow pro- 
duced, depletes the inflamed peritoneum. When there seems to be a 
probability that the pain may be due to the ingestion of bad food, 
and signs of perforation are absent, purgatives may be used to remove 
the offending articles. Should the patient be feeble, purgation is 
contraindicated. 

The tympanitis, which may be a prominent symptom, may be 
relieved in some cases by the use of the rectal tube or of injections 
into the bowel of milk of asafoetida or turpentine emulsion. 

This book is not the place for the consideration of the surgical 



PERNICIOUS MALARIAL FEVER. 597 

procedures to be followed, but it may be stated that in septic peri- 
tonitis in all cases it is a question of operation with probable death, 
or no operation with certain death. In obscure cases of general peri- 
tonitis, where the cause of the disease cannot be found by ordinary 
methods of diagnosis, the writer believes that exploratory incision 
should be done, and after the cause is removed the belly-cavity well 
washed out with hot normal saline solution, and drainage-tube or 
gauze left in for at least twenty-four hours. 



PERITONITIS (CHRONIC). 

Chronic peritonitis is very apt to be circumscribed and to exist in 
connection with chronic appendicular trouble or in females in connec- 
tion with diseases of the organs of generation. The most diffuse and 
curable form of the disease is that known as tubercular peritonitis, in 
w r hich cures have been safely reached through abdominal incision with 
or without drainage or the dusting in of iodoform. Of all forms of 
organic disease affecting the abdominal area and of a chronic type, 
none offer such results to the physician and surgeon as does this, and 
operation ought always to be advised and urged upon the patient most 
strenuously. Care should be taken, however, to separate the subacute 
or chronic process, termed tubercular peritonitis, from the malignant 
and acute form called tuberculosis of the peritoneum, which is often 
only a manifestation of a general infection. 



PERNICIOUS MALARIAL FEVER. 

This is one of the most acutely dangerous diseases known to man 
if it be fully developed, and requires the greatest activity and skill 
on the part of the physician, who may be called upon to treat a large 
number of widely varying symptoms, all of a pressing nature, at one 
and the same time. The chief indication is for the use of quinine in 
its most soluble forms, in solution and in large doses, which may 
amount to 60 or 100 grains (4.0 or 7.0), by the mouth, by the bowel, 
and hypodermically. 

The manner in which quinine acts in malarial poisoning is now 
generally conceded to depend upon its influence over the malarial 
germ of Laveran, which has been so well studied in America by 
Osier and Councilman. All the students of the subject have found 
that at least some of these bodies are made inactive and disappear 
under the influence of the drug, and we have at last obtained a know- 
ledge as to the manner in which quinine does good. which in its 
absence was a constant opprobrium to scientific medicine. The say- 
ino- that "As soon as the physiologist and pathologist tell the thera- 
peutist what disease is, the latter will tell how his remedies do good," 
is very well exemplified by the use of quinine in malaria and the 
present well-founded scientific reasons for its employment. (See Inter- 
mittent and Remittent Fevers.) 



598 DISEASES. 

PLEURITIS, or PLEURISY. 

Under the consideration of Peritonitis the writer has already given 
so full an account of the treatment of acute inflammations affecting 
serous membranes or surfaces capable of throwing out a croupous or 
fibrinous exudate that it seems scarcely necessary to repeat the direc- 
tions here. It is to be remembered that an inflammation of the pleura 
is in many ways identical with an inflammation anywhere. The treat- 
ment of this disease in its early stages is therefore identical with other 
inflammatory diseases, or, in other words, the use of venesection, or, 
better still, of tincture of veratrum viride or aconite to bleed the man 
into his own blood-vessels, is to be resorted to. Along with these 
measures counter-irritation in the way of blisters or depletion by wet 
cups is in order ; but dry cups are never to be used in pleurisy over 
the diseased area, since they may produce ecchymosis of the pleura 
by their suction exercised through the intercostal spaces. Where 
dry cups are used they should be employed at some distant spot, as 
over the skin of the back, where the tissues are too dense to permit 
of pleural involvement by cupping. In cases which are very sthenic 
it is best to give calomel for its aplastic effect in order to prevent a 
fibrinous exudate. By this treatment nearly every case of pleuritis, 
if seen early enough, can be aborted. 

When the pain from the pleurisy is excessive and the movements 
of respiration greatly increase the discomfort, strapping the chest- 
wall may be resorted to. This is done for the purpose of immobil- 
izing the chest. The straps should consist of adhesive plaster, two 
and a half inches wide and long enough to reach from the vertebrae 
to the sternum. They should be applied tightly during expiration, 
slightly overlapping one another at a right angle to the spine, and 
not in the line of the ribs. 

Both in pneumonia and pleurisy a poultice is often useful when 
applied to the chest, but, while this is efficient, it generally soils the 
clothes and slips down to the waist. A cotton jacket is much better. 
It consists of one or two thicknesses of carded cotton basted inside 
a thin undershirt, like a fur-lined coat. On the outside of the shirt 
oil-silk should be basted. By doing this we envelop the chest in a 
warm poultice, because the heat of the body keeps the cotton at the 
proper temperature, while the oil-silk, by preventing evaporation of 
the moisture exhaled from the skin, soon causes the cotton to be moist 
as well as warm. Poultices are for ever getting cold and boggy, and 
if not changed make the patient worse. If they are changed, there 
is danger of the patient taking cold : to avoid such an accident a 
fresh and hot poultice should always be ready by the side of the 
nurse before the old one is taken off, so that as little exposure is suf- 
fered as possible. 

When the second stage of pleurisy, or the stage of effusion, is 
reached, other lines of treatment are needed. The cardiac sedatives 
have been stopped as soon as the quieting of the circulation, the lessen- 
ing of pain, and the absence of a friction-sound denote the passage of 
the case from the first stage to the second. If the pulse becomes weak 



PNEUMONIA. 599 

and the system is depressed, stimulants in the form of alcohol or digi- 
talis are needed, and special care must be devoted to the condition 
of the exudation in the pleural space. If the effusion is sufficiently 
large to cause dyspnoea on exertion, and is not readily removed by 
the administration of salicylic acid in the dose of 1 to 2 drachms 
(4.0-8.0) a day, or saline purges given at the proper time in concen- 
trated form, or if it is not taken up by the vessels after jalap or 
elaterium is used, then resort must be had to aspiration of the liquid 
by the proper apparatus. The physical signs at this time, it will be 
remembered, consist in flatness on percussion over the lower portions 
of the chest, which area of flatness generally varies with the change 
in the position of the patient from the erect to the recumbent posi- 
tion, unless the effusion is sacculated. Blowing or bronchial breath- 
ing at the apex of the lung when this organ is compressed upward 
by the fluid beneath it is often heard. If the effusion is on the right 
side, the apex-beat of the heart is apt to be displaced to the left. If 
it is on the left side, there is obliteration of Traube's semilunar space, 
which is a spot at about the level of the sixth and seventh ribs ante- 
riorly below the nipple, Avhere there is usually a tympanitic note on 
percussion. During this stage of effusion blisters are often very use- 
ful in aiding in the absorption of the liquid which is present. 



PLEURODYNIA. 

This condition, being one of intercostal neuralgia, should be treated 
according to the directions given under the headings of Neuralgia 
and Counter-irritation. 



PNEUMONIA. 

It is of the greatest importance that the physician should employ 
drugs in this disease at the proper stage, in the proper dose, and with 
definite ends in view. In the beginning of a pneumonia of the croup- 
ous type the state of the patient is utterly different, as a rule, from 
that of an individual attacked by the catarrhal form of this disease. 
The first generally attacks a person possessing sufficient vitality and 
force to cause him to suffer an acute inflammation of the tissues 
involved. In other words, the balance of health being destroyed, 
systemic disturbance is far greater than if less vital force was mis- 
directed from its proper functions, and, as a consequence, high fever, 
with increased and excessive arterial tension, rapidly asserts itself, 
the changes in the circulatory system being produced both directly 
by the diseased processes and indirectly by the heat of the body act- 
ing as a stimulant to all its functions. In catarrhal pneumonia the 
systemic changes are, as a rule, somewhat different, since the patient 
is frequently already suffering from some predisposing disease, such 
as whooping cough, bronchitis, measles, or similar affections. If the 
patient is in good condition, the fever and circulatory excitement of 



600 DISEASES. 

catarrhal pneumonia may be equal to that occurring in the croupous 
form ; but even if this be so, there will always be found symptoms of 
loivered vitality which must modify the treatment in the early stages 
of the attack. For a clear and rational understanding of these con- 
ditions the reader should completely grasp the difference between 
them, and under the title of Exhaustion and Depression the writer 
has already defined the differences between these states. 

It is important to emphasize that many diseases, taking pneumonia 
as an example, may be produced in two entirely different ways or in 
two states of the system diametrically opposed to each other. On 
the one hand, we have a pneumonia attacking the lung of a strong and 
healthy individual who may be exposed to cold ; on the other, a pneu- 
monia may attack an invalid recovering from typhoid fever or other 
exhausting disease, such as any one of the exanthems or phthisis. 
The question of the presence of pneumonia is, of course, to be decided, 
but the state of the system is to be the guide in the treatment. In the 
perfectly healthy man who has pneumonia exposure to cold upsets the 
normal balance, and the full force of his system runs riot and must be 
reduced to its proper level. In the weakly individual the curve of 
health has fallen below the normal line and must be raised until it is 
regained. In a sthenic pneumonia there are three stages of treat- 
ment : (1) The depressant or abortive stage, and, if this fails, (2) the 
supportive, followed finally by (3) measures for the relief of the recov- 
ering lung in convalescence. In asthenic adynamic pneumonia we 
must omit all depressant treatment and resort at once to the second 
or supportive measures. The remarks which immediately follow, it 
is to be remembered, have only to do with the so-called first stage in 
sthenic cases. 

If the patient shows symptoms of weakness, as evidenced by the 
pulse and other sign-boards of disease, the treatment is to be consid- 
ered as that of the second stage. 

It should be remembered, however, that the mere fact that either 
stage of the disease is in existence should only lead to a most thorough 
study of the indications present. 

Primary Stage. — The primary stage of pneumonia consists in an 
increase in the calibre of a number of the blood-vessels of the lung, so 
that congestion occurs, and, as a result, the blood stagnates and an 
exudation finally ensues. We have, therefore, a state of the vascular 
system in which all the blood-vessels of the body are tense except 
those which are relaxed by the inflammation in the lung, and the 
blood, flowing in the direction of least resistance, still further stag- 
nates in and engorges the diseased area. All this occurs in the first 
stage, and it is the object of the physician so to decrease the over- 
pressure in the general system that the blood will leave the lung in 
order to obey the law of resistance which has originally caused it to 
accumulate in this locality. 

In those instances where the disease-process goes on still farther 
into what is known as the second stage, or that of consolidation, the 
indications are at once reversed, and the change from the proper plan 
of treatment for the first stage to that necessary for the second may be 



PNEUMONIA. 601 

required very promptly. The stagnation of the blood, combined with 
the pressure exerted by the rapidly-forming exudate, not only narrows 
the patulous vessels by its pressure, but so prevents the expansile 
movements of the lung that proper pulmonary circulation cannot 
occur. As a consequence the right side of the heart is distended at 
first, and exhausted finally by the resistance offered to the blood-stream 
which it is forced to propel, and is simultaneously fed by blood which, 
by reason of the deficient respiration of the patient, is loaded with an 
excess of carbonic acid. Under these conditions the circulatory sys- 
tem must be so stimulated by the physician as to be able to overcome 
the obstruction. 

The methods which may be resorted to during the primary stage 
are very numerous, but there are onlv two which can be recognized 
as of great value, while the other procedures are but subordinate 
measures. These two measures are bleeding and the use of such drugs 
as our clinical and physiological knowledge tells us are proper. The 
discussion of bleeding as a therapeutic measure will be found in Part 
III., and it will readily be seen that the abstraction of blood from the 
entire system will rapidly relieve the diseased lung. The second, and 
by far the best method, is by the use of veratrum viride, aconite, or 
antimony, and perhaps several other drugs of the same class. 

In adults veratrum viride will be found far more useful than 
aconite, while in most instances the reverse will hold true in children, 
in whom aconite always exercises a much more wholesome influence 
than any other drug of this character. Supposing that the disease 
be in the adult, let us for the moment consider why veratrum viride 
in this first stage is so useful a medicament. It will be remembered 
that the two alkaloids of veratrum viride, jervine and veratroidine, 
possess different influences, and that between them they fulfil every 
object w T hich is sought after. According to the experiments of Wood, 
jervine is a most powerful vasomotor depressant, relaxing to a remark- 
able degree the walls of the blood-vessels everywhere ; and not only 
does it do this, but at the same time it so quiets the heart by an action 
upon its muscle or ganglia as to reduce its force, thus preventing 
engorgement of the lung ; while veratroidine by stimulating the inhib- 
itory nerves of the heart slows its beat, fills the ventricles by increas- 
ing their scope and the period of diastole, and allays excitement. 

Further recollection of physiological facts shows us that the blood- 
vessels of the abdomen are capable of holding all the blood in the 
body, and into these will flow the major portion of the fluid which 
is filling the pulmonary vessels, at once lowering blood-pressure very 
greatlv everywhere, so that the lung is starved of blood without dan- 
gerous engorgement taking place in the abdomen. 

The manner of using veratrum viride is a good example of the 
necessity of careful physical diagnosis and a clear idea of what one 
is about to do. Used at the proper time and in the proper amount, 
it is most useful, but when abused it is dangerous or disappointing 
according to the carelessness of the physician. The following case, 

briefly described, is in point : A. E , aged twenty-five, brakeman, 

always strong and well, was much exposed to wind and snow after 



602 DISEASES. 

having been thrown into a profuse sweat by coupling a large number 
of cars. He had a severe chill in the evening, ushered in by a cough 
and followed by fever and a sense of oppression, with somewhat hur- 
ried breathing and pain in the side. At the time of admission into 
the author's wards, three hours after the chill, he had a temperature 
of 103° F., the eyes were bright, the expression of the face slightly 
anxious, Physical examination showed exaggerated breathing over 
the entire right side, while at the base of the left lung posteriorly there 
were marked bronchial breathing and dulness on percussion. Fine 
rales could be heard now and then, but were not constant. The pulse 
was full and bounding. This man was at once given 3 drops (0.15) 
of the tincture of veratrum viride every two hours until such a time 
as he complained of faint nausea, and his pulse was found to be no 
longer rapid and bounding, but soft and slow, while the skin was 
moist and relaxed. The sense of oppression disappeared, the expres- 
sion of anxiety passed away, no pain was felt in the chest, and the 
attack was aborted. 

The employment of veratrum viride in this instance took place at 
a period in which it was possible to quiet the inflammation by " bleed- 
ing the man into his own vessels," or to reduce the hyperemia and 
congestion. If veratrum viride had been used later, it would have 
done more harm than good, as Ave have already shown when discuss- 
ing the state of the inflamed part at the commencement of the second 
stage, for the heart would then be laboring to push blood past the con- 
solidated area, and the disease be fairly started or developed and 
beyond the stage in which its abortion would be possible. 

The advantages of veratrum viride are its completeness and 
rapidity of action ; the fact that it preserves in healthy blood-ves- 
sels the blood which may be needed in the struggle for life if the dis- 
ease is not aborted ; and, lastly, its safety l is a point largely in its 
favor. 

The use of aconite in pneumonia is of particular value in children, 
in whom the emetic effects of veratrum viride often prevent its being 
pushed to a sufficient degree to permit of an effect on the circulation. 
The indications for its employment are identical with those already 
named when speaking of the use of veratrum viride, and the only 
question which arises is as to whether its physiological action and 
clinical record justify its use. In reply to such a query the answer 
may be that it does act favorably in pneumonia, but that it is not as 
thorough in the case of adults as other drugs. The studies of Ringer, 
Achscharumow, Boehm, and Wartmann all prove that the drug is a 
distinct cardiac depressant, but there is no reliable evidence to prove 
that it exerts any vasomotor influence — the fall of arterial pressure, ac- 
cording to most writers, being produced only by the decreased action 
of the heart. On the other hand, there can be little doubt that clinically 
the arterial pressure is decreased by the drug. It at once becomes 

1 Both veratroidine and a resin contained in veratrum viride are powerful emetics^ 
so that upon the ingestion of a poisonous dose of the drug so much is generally vom- 
ited that recovery spontaneously occurs. The symptoms produced are said to yield 
to treatment with remarkable readiness. 



PNEUMONIA. 603 

evident, however, that while its influence is for good in pneumonia, 
it does not possess the scope of action which makes it desirable in 
every case, and yet its powers of producing nervous quiet, allaying 
vomiting, or meeting some idiosyncrasy make it a drug always to be 
thought of in this disease. Antimony, although at one time used 
very largely in the treatment of pneumonia, has very properly ceased 
to be so commonly employed, chiefly for the reasons that it is a poison 
capable of producing decided morbid changes in the tissues, seeming 
to deprive them of their vital power for long periods of time, and 
that it often induces nausea of a distressing type, or even vomiting, 
before it can be pushed to a sufficient degree to cause the desired cir- 
culatory depression. Next to veratrum viride, it holds a more useful 
position in extremely sthenic cases than any other drug, and may be 
used if the patient be unusually robust. Unlike aconite, which ex- 
pends its chief action on the heart, this drug not only quiets and 
slows the pulse by an action exerted directly upon the heart-muscle 
and its motor ganglia, but in addition markedly affects the vasomotor 
system, thereby aiding in causing the desired fall of arterial pressure* 
The proper dose of tartar emetic is y 1 ^ grain (0.005), repeated every 
two hours until the skin shows moisture, nausea asserts itself, or the 
pulse gives evidence of sufficient relaxation. 

Gelsemium has been highly recommended by Bartholow in the 
treatment of the early stages of pneumonia, but is certainly of very 
inferior influence, and is at the same time a dangerous drug. The 
use of chloral has been attempted, but its other powers so dominate 
its action on the circulation as to make it useless for the purpose 
before us. There can be little doubt of the value of pilocarpine in 
the very earliest stages of the malady. Given in full dose hypo- 
dermically, it will produce so profuse a sweat and so great a lowering 
of arterial pressure as to relieve materially the congested lung. Its 
value, however, depends upon its very early employment, and it should 
not be used if any tendency to true consolidation has already asserted 
itself, as it is then useless, and capable of depressing the heart to a 
serious extent when that organ is about to undergo a severe struggle 
because of the engorged lung. 

The application of cold to the chest in the early stages of pneu- 
monia has been resorted to very largely in Germany by Liebermeis- 
ter, Niemeyer, and others. It is said that the dyspnoea is decreased 
at once and the pain lessened. Bartol and Ziemssen speak of it 
highly in the croupous pneumonia of children, but the writer would 
fear to use it in any case unless the patient was above puberty and 
very strong. (See Cold.) 

If cold is used, it should be employed as an ice-poultice made of 
cracked ice and sawdust, mixed and sewed up tight in an oil- silk 
bag in such a way as to prevent the bed and clothes from becoming 
wet. (See Cold, Part III.) At this period, too, very distinct effects 
can be exercised over the blood-vessels of the lung by irritation of 
the skin, w T iiich results in the reflex influence already spoken of in 
the article Counter-irritation. 

The most active means of producing this counter-irritation is by 



604 DISEASES. 

the use of the dry cup. The wet cup may be used to deplete or bleed 
the patient at the same time that it acts as a counter-irritant, but in 
many instances the dry cup will suffice. If the counter-irritation is 
to be thorough, the cups should be applied to the number of five or 
six, scattered over the area involved and a little to the sides of the 
diseased patch. 

In other instances aromatic spirit of ammonia or carbonate of 
ammonia may be used, or alcohol hot and concentrated, in the event 
of collapse. 

Mustard may be employed, and a turpentine stupe (see Turpen- 
tine) or Cayenne pepper can be used as a counter-irritant. The lat- 
ter is at once one of the most efficient and least dangerous irritants, 
as it produces much reddening and irritation, but does not destroy or 
burn the skin. In the beginning of a pneumonia a blister should be 
applied not immediately over the congestion, but a little to one side, 
as it may increase the congestion if placed over the diseased spot. 
When resolution begins, the blister may be placed over the exact spot 
involved, to aid reparative changes. 

The treatment of the second stage of pneumonia, when of a sthenic 
type, is much more difficult and hazardous than the treatment of the 
first stage. The question as to the line separating the first from the 
second stage must be clearly answered in the physician's mind, and 
distinct indications must exist for the employment of measures suited 
to the disease at this period of its development. The physical signs 
in the chest are only of value as evidencing the progress of the local 
disease-process^ and only indirectly indicate the use of a given line 
of treatment, while the state of the pulse, the color of the skin, more 
particularly of the face, the duskiness of the nails, along with the 
rhythm of the respirations, tell the physician how the patient is 
standing the strain. This is not the place to discuss the possible 
causes of death under these conditions, but to indicate clearly what 
is to be done when the flagging to-and-fro pulse indicates arterial 
starvation, and the dusky skin and pulsating jugulars show venous 
engorgement and distention of the right side of the heart. The 
employment of digitalis is here of the greatest service. It should 
be given in 10- to 15-drop doses of the tincture every eight hours, 
and be accompanied by from 5 to 10 drops of tincture of belladonna 
every four hours, or oftener as the case may require. In most 
instances it will be found that the belladonna is absolutely essential 
to control the leaking blood-vessels and to re-establish normal vaso- 
motor tone, which is very important to life. Should the digitalis fail 
and seem slow of action, then a more rapid drug must be used, and 
strychnine is the best in the dose of -^ to -^ grain every four hours. 
The most frequent cause of the failure of digitalis to do good at 
such times is the presence of high fever and a relaxed vasomotor 
system. 

If the digitalis is carelessly given and its eifects are not watched, 
it may be found to produce so rapid and irregular a pulse at the wrist 
as to give one the impression that the heart needs still further doses 
of the drug ; but if the ear be placed over the pnecordium under 



PNEUMONIA. 605 

such circumstances, the violent apex-beat, diffused thrill, and accen- 
tuated heart-sounds will show that this viscus is over-stimulated, and 
that the drug should be withdrawn until some hours have elapsed, and 
its need is evidenced by a condition of real cardiac enfeeblement fol- 
lowing a stage of marked improvement due to the temporary with- 
drawal of the drug. 

Should collapse come on at any time in the course of pneumonia, 
strychnine in full doses (-^ to -fa grain [0.03-0.06]) should be given 
hypodermically, combined with -fa-$ to fa-$ grain (0.0004-0.0006) of 
atropine. These drugs serve to stimulate the respiration and heart 
and improve vasomotor tone. The author cannot too urgently advise 
such treatment, as he believes it will save many lives. Sometimes in 
pneumonia, when there is great duskiness of the skin and nails and 
auscultation reveals a laboring and apparently distended heart, y^- 
grain (0.0006) of nitroglycerin with or without digitalis proves very 
useful. 

Having recommended these drugs in these states, let us study why 
they do good and the reasons for their use. According to a mass of 
experimental evidence, which by its very volume is incontestable, 
digitalis acts upon the heart-muscle as a most powerful stimulant, 
increasing the force of contraction in the cardiac walls and driving 
the contents of the ventricles out into the pulmonary artery and aorta, 
with an unmistakable increase in arterial tension. The experiments 
of Boehm show that the heart actually does more work under digi- 
talis ; and these studies have been confirmed by Williams. Francois 
Frank agrees with Williams in the belief that this increased force is 
due to improved tone of the cardiac muscle. These facts indicate the 
raison d'etre of the use of digitalis in the second stage of pneumonia, 
since it enables the right side of the heart to send the venous blood 
to the general arterial system, thus preventing the over-distention of 
the right ventricle. When we remember, on the one hand, that all 
muscular fibres rapidly become paralyzed by over-distention, and, on 
the other, that digitalis produces a systolic contraction of extreme 
completeness, we can readily see how, by the entire emptying of the 
ventricle at each contraction, distention from gradual accumulation 
is impossible. It seems probable, too, that the pneumogastric nerves 
are the trophic nerves of the heart, and that in consequence its nour- 
ishment is improved by their stimulation by the digitalis. (See articles 
on Heart Disease and Digitalis.) 

There are other reasons, however, which are only second to those 
just named, why digitalis should be used at this time. The heart-beat 
under its influence is greatly slowed, and by means of this slowing the 
patient becomes a cool-headed man instead of a flurried, nervous, irri- 
table invalid. By its very slowing the heart finds time to carry out all its 
functions regularly and with "all its might;" it does not exhaust itself 
by fruitless effort, and accomplishes far more than when it is irregular 
and uncertain as to whether it is to contract or expand. That digi- 
talis slows the pulse by a stimulation of the pneumogastric nerves 
has been proved beyond all doubt, and the remembrance of the fact 
that these nerves are respiratory in function as well as cardiac clearly 



606 DISEASES. 

indicates the value of this influence. They supply motor fibres to 
the muscular coats of the entire bronchial system, the tonicity of which 
is most important for the well-being of the lung, since by this means 
the quantity of air admitted to the vesicles is equalized and the 
excessive use of the healthy vesicles prevented, Longet asserts that 
the "lung tonus" during increased tension (which is present during 
pneumonia) depends solely upon these muscles and their proper nerve- 
supply. These assertions are once more supported by the experi- 
ments of Graham Brown and Roy, which prove that the vagal fila- 
ments are to the lung and its air-streams what the vasomotor nerves 
are to the circulatory system, dilating or contracting the bronchial 
tubes as may be necessary. Digitalis by stimulating them increases 
their tone and supports them when strained. The assertion of Schiff, 
that the vagus is the vasomotor nerve of the lungs, is only partly 
true, and is so doubtful as to prevent any value being derived from 
this fact, so far as the blood-supply is concerned. Another way in 
w r hich digitalis does good is often overlooked. The respiratory centre 
is governed solely by the condition of the blood. If this fluid be 
overladen with carbon dioxide, it sends out more impulses and rids 
itself of the gas by the increased respiratory effort, or, if an excess 
of oxygen is present, it sends out fewer impulses until the normal 
balance is restored. If, however, the carbon dioxide is not rapidly 
eliminated, the combined effects of the gas and effort speedily decrease 
the respiratory activity. It is also to be remembered that Marckwald 
has proved that the pneumogastric nerves are the regulators of the 
impulses sent out by the respiratory centre, so that a perfect rhythm 
is obtained. The asphyxia due to the laming of a lung by pneumonia 
increases the number of respiratory efforts, and in consequence the 
labor of the vagus is increased. Very commonly w T e see cases of 
pneumonia in which the breathing is hobbling, with a distinctly 
altered rhythm — now fast, now slow ; now full, now deep. In these 
the breathing becomes regular and quiet after digitalis is used in the 
proper amount — a result often accorded to the cardiac influence of 
the drug, but largely due to its effects on the respiratory portion of 
the vagus nerves. The same advantages are gained by a regulated 
respiratory effort on the part of the lungs as are obtained in the case 
of the steadied heart. 

In those cases where digitalis is pushed too far, these favorable 
effects are replaced by the most unfavorable conditions, as has already 
been described in the discussion of the action of this drug in heart 
disease. Here, as elsewhere, over-stimulation is as bad as lack of 
proper tone. 

Strychnine is used to carry out an object supplementary to that of 
digitalis, for it has been proved to be one of the most reliable and 
powerful stimulants upon the respiratory centres that we have, and 
they are apt to be exhausted by rapid breathing. It also prevents 
general nervous depression, and aids in the maintenance of a circu- 
latory balance by its stimulating effect on the vasomotor system and 
heart-muscle. 



PNEUMONIA. 607 

In many cases the heart seems strong enough, but the blood-ves- 
sels relaxed and the pulse compressible. Atropine or belladonna, 
when used at this time, stimulates the vasomotor system and dries 
the leaking skin. 

The employment of alcohol in the second stage of pneumonia is 
based upon the same principle as is the use of digitalis. It is inferior 
to the latter drag, because it stimulates the heart and increases its 
force, but does not afford it the nutrition that digitalis can give it. 
That is to say, it stimulates and causes the expenditure of all the 
power the heart is capable of, but does not replace the tissue destroyed 
hy the effort. Further than this, it possesses the disadvantage of act- 
ing for a comparatively short time, dose for dose, and tending to cause 
cerebral excitement or heaviness if it is pushed to the point of stimu- 
lation required by the circulatory condition. In persons addicted to 
the excessive use of alcohol it either fails to act, produces effects con- 
trary to those desired, or actually aids the disease-process. The 
danger of the patient forming the alcoholic habit is also to be remem- 
bered. In children, however, alcohol and ammonia act, as a rule, 
hetter than does digitalis. 

Having detailed this treatment of the second stage, that for the 
third stage is to be considered. For the thorough understanding of 
this we should remember that this stage consists in the breaking down 
or resolution of the exudations and in their absorption and expulsion 
from the chest. 

At this time the entire diseased area is crowded with secretions 
which have been formed, dead epithelial cells, and all the morbid sub- 
stances which have accumulated. The local surfaces are depressed by 
the reaction following upon the excitement of inflammation, and their 
tone is below par. The object of the physician must be to stimulate 
these areas so that they may throw off the old and take on a new 
functional activity, and for this purpose remedies are to be used which 
will soften deposits and stimulate depressed vesicles and bronchial 
tubes. 

By far the most valuable class of drugs to be here employed are 
those which will increase the secretion from mucous membranes with- 
out acting as cardiac depressants. Antimony is a remarkable drug 
for the production of a large secretion, but is often too depressing to 
the heart after the prolonged strain to which it has been subjected. 
Under the article on Bronchitis the action of these drugs will be found 
more thoroughly explained, but it will suffice to point out, at this time, 
the method of their administration. 

First and foremost stands the chloride of ammonium, a drug whose 
elimination takes place laro-ely through the lungs, and which acts most 
happily in aiding in the loosening of the cough and secretions. Its 
only disadvantage is its salty taste, which in many cases renders it 
disagreeable to the patient, while its irritant properties may disorder 
the action of the stomach, although if this organ is depressed and 
atonic this drug often improves its condition. This drug may be given 
in compressed pills, or, what is far better, in such a mixture as here 
follows : 



608 DISEASES. 

R. — Aramonii chloridi ^ij (8.0). 

Extract, glycyrrhizse fl. - ^ij (8.0). 

Aquas dest. . . . fgiij (96.0).— M. 

S. — Teaspoonful (4.0) in water every four hours during the day. 

If the cough be in excess of the expectoration — that is, if the 
cough often fails to bring up phlegm and is due to tickling or irrita- 
tion — it may be relieved by the addition of a little morphine to this 
mixture, as follows : 

R. — Morphinse sulph gr. j vel gr. ij (0.05-0.1). 

Amrnonii chloridi 3;ij (8.0). 

Extract, glycyrrhizte fl £iv (16.0). 

Aqua- dest ^vj (192.0).— M. 

S. — Dessertspoonful (8.0) every four hours. 

If much more morphine than this is used, it will tend to stop secretion. 
When the chloride of ammonium fails to act favorably, the car- 
bonate may be called into use for its local and circulatory action, and, 
in addition, the bromide of ammonium may be employed to allay the 
cough if morphine cannot be used. The following prescription is 
valuable : 

R. — Amrnonii chloridi 7,] (4.0). 

Amrnonii bromidi 3j (4.0). 

Amrnonii carbonat 5J (4.0). 

Extract, glvcyrrhiza? fl giij (12.0). 

Aqua- dest/." f^vj (192.0).— M. 

S. — Dessertspoonful (8.0) every four hours. 

(For other remedies for this stage see Bronchitis.) 

So far, the treatment given has dealt with a routine case : let us 
suppose that things run less smoothly and complications arise. It 
will be impossible, in a book on Therapeutics, to explain the causes 
of all the dangers which may present themselves. One of the most 
serious of them is an increase in the area of the consolidation or its 
development elsewhere, or, in other words, a second attack super- 
imposed on the first. The treatment of this most dangerous state 
of affairs requires the greatest care, skill, and intelligence, and con- 
sists primarily, not in the use of cardiac sedatives, but in the admin- 
istration of digitalis and stimulants, in order to drive out the blood 
from the new congestion or to enable the system to bear the strain. 
A blister or dry or wet cup thoroughly applied a little to one side of 
the spot involved may aid in the removal of the congestion, and the 
application of mustard plasters to the feet is indicated, or a turpentine 
stupe may be applied to the entire chest. The use of expectorants 
stimulating to the lungs is to be stopped at once, and nourishment 
given in small amounts, carefully prepared and frequently adminis- 
tered. It is to be remembered, however, that, above all things, the 
physician must use his judgment, and if he finds that sufficient strength 
yet remains to his patient for the second attack to partake of a dynamic 
or sthenic character similar to that of the first, he must use bleeding, 
leeching, cupping, or cardiac sedatives. 

If the consolidation be very widespread in any case, the entire 
heart becomes strained by the venous congestion and arterial tension 



PRURITUS. G09 

due to the partial asphyxia, while there is also danger of death from 
lack of oxidizing space for the blood. No better treatment exists, 
under these circumstances, than the inhalation of oxygen, either 
almost pure or mixed with air. By this means even a small patch 
of lung oifers sufficient oxygen to the blood to cause its necessary 
oxidation. This gas may be obtained in small cylinders, which, by 
compression of the gas, hold forty gallons, at several large establish- 
ments, notably at the offices of the S. S. White Dental Company, 
which has agencies in all the large cities of the United States, or it 
may be made by the physician himself in the following manner: 
Take 4 ounces of chlorate of potassium — which must not contain a 
single chip or piece of organic matter — and add to it an equal quan- 
tity of peroxide of manganese. These should be placed in a retort 
or strong flask, and an alcohol-lamp placed under it. The gas as it is 
generated escapes through a tube, which should pass into a large jar 
of water, so that the gas, as it bubbles up, may become cooled and 
purified ; a second tube may now lead the gas to an inhaler over the 
patient's mouth. It should be remembered, however, that chlorate 
of potassium may explode if contaminated by the smallest piece of 
organic matter. 1 

The period in the treatment of pneumonia when simple poultices 
do the greatest service, and the only time when they are to be 
employed, for valid reasons, is during the second and third stages of the 
disease, when clinical experience shows that they are of value in aid- 
ing in the production of resolution and in loosening the cough. How 
they act, except by increasing the external warmth and moisture of 
the parts, we do not know, unless by the production of some reflex 
influence exerted upon the lungs from the skin by means of the 
nerves. Unless the attendant is unusually intelligent and well 
trained, the common poultice does more harm than good, because it 
is allowed to get cold or the patient is chilled when it is changed. 
The proper application is the cotton and oiled-silk jacket, particularly 
in young and restless children. 

The remarks which have just been made deal entirely with simple 
poultices, and not with those possessing drugs in their mass, such as 
those agents belonging to the counter-irritant group of drugs. By 
far the most commonly used substance under these circumstances is 
mustard, and its addition to the mass at once allows this method of 
treatment to be employed in the first as well as in the later stages. 



PRURITUS. 

Itching of the skin or mucous membranes about the openings of 
the body is a very common state, and while it may be dependent upon 
local causes, such as lice or fleas, it more commonly is due to some 
systemic condition, such as debility, diabetes, gout, or renal disease, 
or other similar causes. The treatment consists, first, in the removal 

1 Several firms manufacture small yet complete forms of apparatus for the man- 
ufacture and clinical application of oxygen. The cost varies from $25 to $50. 
39 



610 DISEASES. 

of the cause, and, next, in the local treatment of the condition. There 
is generally no redness or eruption, except that due to scratching. 

Internally, arsenic, quinine, bitter tonics, cod-liver oil, alkaline 
diuretics, or mineral waters are useful in debilitated cases, and an 
avoidance of condiments, such as mustard or pepper, is needful if the 
disease affects the mouth of the urethra or vagina. 

The local treatment of pruritus consists in the use of lotions, 
salves, or ointments made up of various constituents, a number of 
which are capable of acting as local anaesthetics. Very often, bathing 
the parts with 1 drachm of bicarbonate of sodium or of borax to a 
pint of cold water gives relief temporarily, or the following formulae 
will be of service : 

R,-Acidicarbolici f^j vel f^ij (4.0-8.0). 

Aqua? dest q. s. ad Oj (500 cc.j.— M. 

S. — Apply as a lotion several times a day. 



Or, 



R. — Liquor carbon, detergen. 1 .... f^ij (8.0). 

Aquae q. s. ad Oj (,500 cc). — M. 

S. — Apply as a lotion. 



Or an ointment made as follows is serviceable: 

R.— Acidi earbolici gtt. v vel xx (0.3-1.3). 

Adipis benzoinatus . ,5j (32.0). 

Petrolati £j (4.0).— M. 

S. — Apply as an ointment. 

In other cases 10 to 20 minims (0.65-1.3) of chloroform may be 
used in place of the carbolic acid. 

Cocaine may be painted over the parts, but it should rarely be 
used in ointment, as fats prevent its acting effectively. It should 
also be remembered that the anal and vaginal mucous membranes are 
so thick that strong solutions of cocaine are necessary to produce 
anaesthesia, and that the effects of cocaine are only temporary. 
Where the itching is very obstinate the parts may be painted with a 
solution of nitrate of silver of the strength of 20 grains to the ounce 
(1.3 : 32.0) of water, cocaine having been previously applied to 
relieve the pain of the application. (See article on Cold.) Brinton 
has highly recommended powdered teucrium scordium in the dose of 
20 grains (1.3) three times a day. 



PUERPERAL DISEASES. 

The diseases of the puerperium may be divided into two broad 
classes — infectious and non-infectious. The first class should be 
further subdivided into (1) those infectious diseases in which the 
point of infection has been somewhere along the parturient tract, 
and (2) those in which the infecting poison has entered the body by 
some other channel. Under sub-heading 1 come all those diseased 

1 For method of prepnring this liquor see article on Eczema. 



PUERPERAL DISEASES. 611 

conditions grouped together under the very inadequate generic terms 
" puerperal fever," "puerperal septicaemia," "puerperal infection," 
and the like, none of which truly express the condition present. If 
it is necessary in medical nomenclature to have a single term which 
shall denote infection of the genitalia after delivery, a word should 
be coined strictly limited in sense to mean the pathological conditions 
which result from the activity of pathogenic microbes along the whole 
genital tract. This classification is necessary for a clear and system- 
atic description of the treatment of diseases in the puerperal state. 

The Treatment of Infection along the G-enital Tract after Labor. — 
By far the most common form of infection along the genital tract 
after labor is the absorption of ptomaines from the infection and 
decomposition of membranes, fragments of placenta, or blood within 
the uterus. This condition will be found in more than 75 per cent, 
of all cases in which infection occurs. Therefore, in any case after 
labor in w T hich there is fever that cannot be explained by some evi- 
dent cause independent of the genitalia, it is safe to assume ptomaine 
poisoning and to act accordingly. The indications are plain: to 
destroy the microbes, and thus at once stop the manufacture of their 
poisonous products, and, if necessary, to remove their habitat. 

The writer's routine application of this principle in practice is as 
follows : If the temperature after delivery remains over 100° F. for 
twenty -four hours without evident cause independent of the genitalia, 
he washes out the uterine cavity with at least 1 quart (1 litre) either 
of bichloride-of-mercury solution, 1 : 2000, or a 2 per cent, solution 
of creolin. The former is more convenient in private practice, be- 
cause the tablets of corrosive sublimate can be easily carried about in 
one's instrument-bag. To ensure the entrance of the antiseptic fluid 
to the fundus and its free exit from the cervical canal an intra-uterine 
catheter is desirable. Of all those upon the market, the best is that 
manufactured by Lentz, an instrument-maker of Philadelphia. If, 
how T ever, the cervical canal is patulous, as it usually is after labor, a 
hard-rubber catheter attached to a Davidson's or fountain syringe 
answers the purpose perfectly. 

In the majority of cases this treatment will bring the temperature 
down to normal within twenty-four hours. If fever does not disap- 
pear within this time or perhaps rises even higher, the second indica- 
tion must be met. The infected albuminous substance w r ithin the 
uterine cavity must be removed in order to deprive the micro- 
organisms of their feeding-ground. This is best accomplished by the 
use of the curette and the placental forceps, care being taken in the 
employment of the former instrument to guard the uterine wall itself 
from the slightest injury; for not only can the uterine muscle be per- 
forated by a curette in clumsy hands, but slight wounds of the uterine 
substance w r ith this instrument may be enough to inoculate the gen- 
eral system w T ith the germs whose activity has been confined before to 
the uterine cavity. 

The writer's manner of employing this plan of treatment after 
labor is as follows : 

The anterior lip of the cervix is seized with a double tenaculum 



612 DISEASES. 

and pulled gently downward ; a cleansing uterine douche is then 
given in order to disinfect the field of operation; next the curette is 
inserted to the fundus, and the whole interior of the uterus is carefully 
gone over with the instrument, first the fundus and then each of the 
four sides ; then the curette is turned with the scraping surface upward 
and withdrawn from the cervical canal, a finger in the vagina meet- 
ing its' tip as it emerges in order to help extract any substances which 
may be caught by and entangled in it. 

Next the placental forceps is inserted, and an effort made to grasp 
any material lying loose within the cavity or still attached to the 
uterine walls. It is usually best to repeat each of these manoeuvres 
several times until nothing more can be brought away except a little 
clear blood. 

Then the uterine cavity is again thoroughly washed out. The 
writer has many temperature charts in his possession which show 
the success of this treatment when simple uterine irrigation has 
failed. Occasionally it is necessary to repeat the irrigation, and even 
the curetting, for several successive days. If, as rarely happens, 
this treatment should prove unsuccessful and the temperature should 
remain elevated in spite of irrigation and the use of the curette and 
placental forceps, one must assume either that general systemic infec- 
tion has occurred, or at least that an inflammatory action has begun 
in the uterine walls or within the tract of the tubes. One of the 
earliest, surest signs of systemic invasion is the appearance of 
peritonitis. 

In such a case the only available treatment is to support the body- 
cells in the combat which they must wage with the invading micro- 
organisms. This is best accomplished by the administration of as 
large a quantity of nutriment as the patient can stand without rebel- 
lion of the stomach or bowels, and the exhibition of a large quantity 
of alcoholic stimulant. Cases of this sort not infrequently require 
more than a pint of whiskey or brandy in the twenty-four hours. 
Occasionally measures will be required to reduce an exaggerated ele- 
vation of the temperature, but this is best avoided as long as possible, 
for antipyretic treatment is usually depressing and ill suited to the 
patient's adynamic condition. 

With this plan of treatment about three-quarters of the cases of 
general septic infection after labor will recover. There may be some 
in which metastasis to important organs occurs so early as to render 
all treatment of no avail. There will be others in which the peri- 
toneum is early infected, and in which the septic peritonitis develops 
rapidly and to an extensive degree. It is in such cases that laparot- 
omy and evacuation of the septic matter, usually pus, within the peri- 
toneum will occasionally save life. The physician must guard him- 
self, however, from the disposition which is prevalent at this day to 
operate too early and unnecessarily. After operation, drainage of the 
peritoneal cavity is an essential feature of the treatment, even although 
the evidence of suppuration within the cavity is slight. The writer 
has in mind a case in which an operation was performed ten days 
post-partum for septic peritonitis : a very small quantity of purulent 



PUERPERAL DISEASES. 613 

lymph was found upon one ovary, which was greatly enlarged and 
contained a small quantity of sero-pus. The ovary was removed and 
the abdomen closed without drainage, as there was no other evidence 
of suppuration within it. Thirty-six hours later the patient died, 
and the peritoneal cavity was found filled with pus which had accu- 
mulated in that short space of time. In the early stages of the 
peritoneal infection, if the subject is vigorous, not exhausted by a 
prolonged labor or other depressing causes, the administration of 
saline ourgatives in concentrated solution will often effect brilliant 
results. 

The writer's custom is to give a dessertspoonful of a concentrated 
solution of Epsom salts every fifteen minutes until free evacuation of 
the bowels is secured. He has seen the temperature reduced by this 
plan of treatment from 104° F. to normal in the course of twelve 
hours, and with the reduction of temperature all the symptoms of 
peritonitis, which were well marked, entirely disappeared. 

In the treatment of microbic activity along the parturient tract after 
labor it should never be forgotten that the point by which the microbes 
invade the system may be anyAvhere from the fundus of the uterus to 
the parturient outlet ; therefore the practitioner should never neglect 
to examine carefully all the lower parturient tract, in order to detect, if 
possible, an ulcerated surface covered by diphtheritic membrane, which 
if overlooked might be the entrance-point for a fatal infection. These 
unhealthy surfaces are best detected by the use of a cylindrical speculum 
of clouded glass introduced so that the cervix appears within its inner 
end, and then withdrawn, so that the vaginal mucous membrane as it 
prolapses into the end of the speculum may be examined, and treated 
if necessary throughout its whole extent. If an unhealthy, ulcerated 
wound is thus discovered, the writer's practice is to apply to it a solu- 
tion of nitrate of silver 40 or 60 grains to the ounce (2.65 : 32.0). 
In the vast majority of cases this application will promote an exfolia- 
tion of the unhealthy membrane and the appearance of healthy gran- 
ulation tissue within a few days. 

It may, in some cases, be necessary to employ a stronger applica- 
tion, as the solution of chloride of zinc, but the writer has not been 
driven to its use. The most common point of infection outside the 
parturient tract after labor is some portion of the urinary apparatus, 
almost invariably the bladder. The process of parturition necessarily 
diminishes the vitality of the vesical mucous membrane cells by the 
pressure and stretching to which they are subjected. After labor, 
therefore, they are not in a condition to resist the attacks of micro- 
organisms should these in any way gain access to the vesical cavity. 
Most commonly microbes are introduced into the bladder by a cath- 
eter. This, however, is not necessary, as it has been plainly demon- 
strated that they can wander from the vaginal canal through the 
urethra into the bladder without the intervention of an instrument 
which would directly carry them into the vesical cavity and deposit 
them in that situation. Once arrived within the bladder, the microbes 
attack the depressed bladder-cells, and very often gain a lodgment 
in the vesical mucous membrane. This is manifested by the usual 



614 DISEASES. 

symptoms of septic cystitis — fever, pus in the urine, pain on pressure 
over the hypogastrium, and pain and difficulty in micturition. The 
duration of these symptoms is, as a rule, not very long. The fever 
subsides and the symptoms of cystitis disappear. After an interval 
of some days, however, there is again a sharp outbreak of fever, with 
pain in the region of the kidneys and the reappearance of pus, or at 
least of numerous microbes, in the urine. This indicates a septic 
infection of the pelves of the kidneys after the micro-organisms have 
migrated along the ureters. During their migration their presence 
has not been manifested by any symptoms. In the majority of cases 
even the symptoms of pyelitis will disappear after a time, and the 
patient will make a good recovery ; but in a certain proportion there 
is a systemic infection by the direct passage of microbes or their 
products from the kidneys into the blood. There may be an extensive 
suppuration of the kidneys and surrounding tissue, with fatal results, 
or, as the writer has seen in several cases, the symptoms of general 
systemic infection become so grave as for a long time to threaten the 
patient's life. In the worse cases of bladder infection the mucous 
lining sloughs, peritonitis develops, and the patient dies before the 
disease has time to spread to the kidneys. 

The practitioner, bearing in mind the serious consequences of sep- 
tic cystitis after labor, should always be on the watch for it, and 
should adopt an energetic treatment immediately upon its discovery. 
A thorough disinfection of the bladder will remove all present symp- 
toms, and prevent the occurrence of grave and possibly fatal after- 
complications. To accomplish this purpose the writer employs a J 
of 1 per cent, solution of creolin. One injection of a quart of this 
solution through a two-way catheter is usually sufficient. Occasion- 
ally it is necessary to repeat it or to follow it by several injections 
of boric-acid solution. In susceptible individuals creolin causes too 
much pain to be employed. A 1 : 8000 bichloride-of-mercury solu- 
tion may be substituted for it, or in mild cases a solution of boric 
acid alone will be sufficient. 

If, in spite of all precautions, infection of the kidneys should 
ensue, a vigorously stimulating and supportive plan of treatment 
affords the only hope of success. If extensive suppuration occurs in 
the kidneys, all treatment will of course be useless. 

Perhaps the most uncommon point of septic infection after labor 
is the rectum. The writer has, however, seen one fatal case of this 
sort — from the use, no doubt, of a dirty syringe-nozzle in the hands 
of a careless nurse. It would be difficult, or perhaps impossible, to 
diagnosticate such a case until after death, and therefore treatment 
directed toward this form of infection will usually not be adopted. 

Next in frequency to the parturient tract and the urinary system 
as a region of infection after labor come the breasts. Infection of the 
nipples, and a consequent mammary inflammation or suppuration, is 
one of the most troublesome minor complications that the obstetrician 
is called upon to treat. By careful preparation of the nipple during 
the last month of pregnancy, and by extreme care to secure perfect 
cleanliness during the period of lactation, infection of the breasts can 



PUERPERAL DISEASES. 615 

almost surely be avoided. If it occurs, the first effort should be to 
limit its extent and degree, and to prevent, if possible, suppuration. 
The best means to accomplish this end are derivation of the blood 
from the mammary glands by an active purge, compression of the 
gland-substance, and support of the breasts by a suitable mammary 
binder. 

To these should be added, -in the acute stage of inflammation, 
fomentations of very hot water, and, later, the application of cloths 
wrung out in lead-water and laudanum, renewed every three hours. 
Unless the infection has been of a virulent nature and the amount 
of infective material large, this plan of treatment will almost surely 
dissipate the inflammation and prevent suppuration. 

The other infectious fevers of the puerperal state include the in- 
fectious diseases which can, under any circumstances, attack the adult 
female, and their treatment differs in no respect during the puer- 
perium from that adopted under ordinary circumstances, unless there 
should be developed some local complications. 

Non-infectious Diseases of the Puerperium. 

Anomalies of Involution. — Superinvolution, an exaggeration of 
that process by which the uterus is reduced to its normal size after 
labor, only manifests itself, as a rule, after the puerperal state is com- 
pleted, and therefore its treatment need not be further considered. 

Subinvolution, an arrested or retarded return of the uterus to its 
normal condition and dimensions after labor, is one of the commonest 
complications with which the obstetrician has to deal in the manage- 
ment of the puerperium. The cause of subinvolution is always a 
local one. General conditions, as acute fevers and so on, have no 
influence whatever upon the process of involution unless they are 
accompanied by some local complication. 

There are two causes which prevent the involution of the uterus 
which must be borne in mind when one is called upon to treat this 
condition. The involution may be prevented, on the one hand, by 
anything which calls an excessive amount of blood to the uterine 
body, as, for instance, small fibroids within its walls or hypertrophied 
deciduous membrane remaining adherent to its inner surface. On 
the other hand, subinvolution may be the result of mechanical obstruc- 
tion to the contraction of the uterine walls and the reduction of the 
cavity of the uterus to the normal size. As an example of this we 
have a retained placenta or a submucous fibroid or adhesions dragging 
the uterus out of place and preventing its contraction, or, most com- 
monly perhaps, an over-distended bladder and rectum. 

In those conditions which result in a hyperemia of the uterus the 
cause of an excessive blood-supply must be sought out and removed 
before one can remedy the subinvolution. 

If small fibroids can be detected, the administration of quinine, 
ergot, and strychnine in pill form has been found most useful. If 
practical, a faradic current may be employed in addition to medica- 
tion. If there is an hypertrophied endometrium retained within the 



616 . DISEASES. 

uterus, a curette Avill most quickly and effectually hasten involution. 
In cases of heart disease in which the blood-current is sluggish and 
dammed back into the large veins of the trunk digitalis will be the 
most effective remedy to overcome the subinvolution. There may be 
an active hyperemia associated with inflammatory action, either in 
the uterine wall or upon its peritoneal covering or in its annexa ; in 
this case the inflammation must be overcome by disinfection, the use 
of purgatives, and. possibly, the local application of hot water, before 
involution can be secured. When there is mechanical obstruction to 
the return of the womb to its normal dimensions, the hindrance must 
of course be removed before one can expect a good result from treat- 
ment. In the case of retained adherent placenta every effort must 
be made to remove the placental tissue. In the case of submucous 
fibroids their removal must be attempted if there is any hope of safely 
accomplishing it. 

There is no case of labor which does not leave behind, in the par- 
turient tract, some injury to the maternal structures. Usually these 
are slight in degree, manifesting no symptoms and healing spontane- 
ously. Occasionally the injury done results in fistula communicating 
with the bladder or rectum, in deep granulating wounds in the vagina, 
or in ulcerated sores. 

In the case of fistula a cure can sometimes be effected without 
operative interference by touching up the edges of the fistulous tract 
with nitric acid, in order to excite an outpouring of granulation tissue 
in the hope that it may plug up the opening. In deep tears, which 
have not been primarily united, application of a solution of nitrate 
of silver will hasten the cure and prevent infection of the wounded 
surface. If ulceration occurs, the ulcerated spots are to be carefully 
watched and treated in the same manner. 

Hemorrhages from the birth-canal after labor depend upon a num- 
ber of well-known causes, which must be sought out and corrected 
before the bleeding will cease. Most frequently the cause of a hem- 
orrhage will be found in retained placental fragments in utero, which 
must be removed. Not infrequently displacements of the uterus will 
be found as a cause, and correction of the displacement will stop the 
bleeding. 

In interstitial bleeding;; after labor, resulting in hematoma, care 
must be taken to preserve the parts in as aseptic a condition as pos- 
sible, while an attempt is made to limit the bleeding by the applica- 
tion of direct cold, preferably by means of a Barnes bag dilated with 
ice-water, which must be removed from time to time in order to allow 
the lochia to escape. After rupture or incision of these blood-tumors 
the cavity left behind must be carefully disinfected with the bichlo- 
ride-of-mercury solution or creolin, and, if necessary to control further 
bleeding, well packed with iodoform gauze. 

Of all forms of bleeding, that which occurs directly after labor in 
consequence of inertia uteri, known as post-partum hemorrhage, is 
the most frequent, the most alarming and dangerous in its manifesta- 
tions and consequences. No one should attend a case of obstetrics 
without having in mind a clearly-defined programme to be put in 



PUERPERAL DISEASES. 617 

immediate execution when called upon to deal with this frequent and 
dangerous complication. There are two indications to be met : First, 
to control the hemorrhage, and, second, to treat the after-condition. 
The first indication is met by the following plan of treatment : 

External stimulation of the uterus by kneading and rubbing 
through abdominal walls, as is practised in Crede's method of 
expressing the placenta. 

Next carry the other hand into the uterus and remove any blood- 
clots, pieces of placenta, or membrane that may be found there, so 
that the internal surface of the uterine walls is irritated by the move- 
ments of the operator's fingers. 

Next apply a small piece of ice upon the abdomen externally, and 
carry another piece the size of a hen's egg into the uterine cavity. 
The use of cold must not be persisted in for more than a minute at 
most, for its ultimate action is depressing and relaxing. 

Next soak a clean linen handkerchief in vinegar, carry it up to 
the fundus, and squeeze it out so that the vinegar shall run down 
over the uterine surface. 

Next, hot water at a temperature of 116° or 120° F. should be 
injected into the uterine cavity. 

If one happens to have the necessary appliances at hand (a small 
Gaiffe battery, which can be carried in an ordinary instrument-bag), 
a strong faradic current can be applied to the uterine muscle. 

Finally, as a last resort, the uterine cavity may be packed with long 
strips of iodoform gauze in the manner suggested by Diihrssen and 
carried out by a number of observers with gratifying success. 

Drugs, as the styptic salts of iron, and especially Monsel's solu- 
tion, have been recommended from time to time as intra-uterine appli- 
cations in the case of post-partum hemorrhage, but they are dangerous, 
for the coagulation produced by them may extend far into the uterine 
vessels, and the clots must be broken up by putrefaction, exposing the 
patient to the danger of septic poisoning. 

This programme is to be carried out in the order given : if the 
milder measures suffice, of course the more radical plans of treatment 
will not be employed. Excessive hemorrhage (post-partum) from 
lacerations along the genital canal can be controlled by well-placed 
sutures. 

Bearing in mind this plan of treatment, it is almost inconceivable 
that an intelligent and skilful practitioner should lose a case of post- 
partum hemorrhage. 

The physician should give ergot in full dose by the mouth and, if 
need be, hypodermicallv. 

Treatment of the After-condition. — While the physician is busy 
controlling the hemorrhage the nurse should administer a hypodermic 
injection of ether if symptoms of shock or collapse are manifested. 
After the bleeding has ceased it is well to administer an enema of a 
pint of hot water, which maintains the patient's temperature, relieves 
the shock, and by its irritation promotes contraction of the uterine 
muscle. This should be succeeded by small doses of hot, strong 
brandy-and-water, and a little warm milk if the stomach will retain 



618 DISEASES. 

it. As soon as reaction is well established a half-pint (250 cc.) of 
hot beef-tea should be administered, and a hypodermic of ^ grain 
(0.008) of morphine given in order to secure quiet and rest and to 
get the stimulant qualities which this drug undoubtedly possesses. 
Occasionally measures must be adopted to retain enough blood within 
the large vessels and in the heart to prevent excessive cerebral anaemia 
or cardiac failure. This is best done by auto-transfusion ; that is, by 
bandaging the extremities from below upward, in order to secure as 
large a quantity of blood as possible within the vessels of the trunk 
and brain. Actual transfusion of a T 6 ^-of-l-per-cent. solution of com- 
mon salt into the blood-vessels is required Avhen there are profound 
exhaustion and depression after hemorrhage. It has been demon- 
strated that it is not necessary to throw this solution directly into 
the blood-vessels, as interstitial injection seems to answer the pur- 
pose equally well. 

The milk secretion during the puerperal state presents abnormal- 
ities which call for treatment. One may have to deal with anomalies 
of quantity or quality. The most frequent anomaly of quantity in 
milk secretion is unfortunately one of defect. Insufficient milk-supply 
depends on a number of causes. Perhaps the most frequent is a 
lack of development of the glandular tissue, and in this form of 
insufficient milk secretion no treatment can be of avail. When the 
lack of milk is due to some intercurrent affection in the puerperal 
state the treatment must be directed toward this complication before 
the milk-supply can be re-established in normal quantity. It may 
be the consequence of hemorrhages or of diarrhoea, or the result of 
an acute febrile attack during lactation, or of inflammation within 
the gland itself. Serious organic disease may also be a cause, and 
insufficient nourishment must be held accountable in some cases. 
Profound emotions exert an extraordinary influence upon lactation 
in altering both the quantity and the quality of the milk. It has 
long been supposed that the return of menstruation has a disastrous 
influence upon milk secretion. This, however, has been definitely 
disproved by careful observations recently conducted in Austria. 
The return of normal menstruation without complications has no 
apparent influence, as a rule, upon the quantity or quality of the 
woman's milk. In all the temporary diseases interfering with milk 
secretion described above it should be borne in mind that on the dis- 
appearance of the abnormal general or local condition milk secretion 
can be successfully re-established, even though it be absent for days 
or weeks. Electricity has been much vaunted of late as a remedy 
for insufficient lactation. It may be applicable in cases of torpidity 
of the mammary gland or in those cases where lactation has been 
suppressed on the birth of a first child, and where the mammary 
gland, therefore, does not respond readily to the stimulus of subse- 
quent births. This remedy will, however, often prove ineffective and 
disappointing. 

Instances of excessive milk secretion are not infrequently met with. 
In the milder and simpler forms they can be managed by regulation 
of the diet and free purgation. Galactorrhea, a constant flow of 



PUERPERAL DISEASES. 619 

milk from the breasts, is one of the most stubborn forms of excessive 
milk secretion. Two measures can usually be relied on to give relief: 
firm compression of the mammary gland with the application of bella- 
donna ointment, or the administration internally of iodide of potas- 
sium. In some cases of this character milk secretion stops sponta- 
neously with the return of menstruation, and in a certain proportion 
of cases a treatment to secure a discharge of blood from the uterus 
has been successful in stopping the flow of milk. - Success has been 
obtained with Simpson's plan of introducing a piece of caustic within 
the uterus in order to bring back the menstrual flow. Warm douches 
have been used successfully for this purpose. Electricity has been 
recommended to secure the proper contraction of the sphincter muscles 
of the lactiferous ducts, but as this is usually a result, and not a cause, 
of the galactorrhoea, the use of electricity must prove in the vast 
majority of cases ineffective. The long-continued administration of 
ergot has been warmly recommended. The remedy should be tried, 
for its use seems rational. Chloral has been shown to be very effective 
in diminishing the quantity of milk. This drug, therefore, is worthy 
of trial. It has recently been declared that antipyrine, in 2J-grain 
(0.12) doses three times a day, will diminish milk secretion. The 
drug, however, has not been tested often enough to demonstrate its 
power. Quantitative anomalies in the milk secretion must often 
depend upon an ill-regulated diet. A fatty diet will diminish the 
quantity of milk ; a vegetable diet will diminish the casein, and fat 
will increase the sugar; a diet rich in meat, especially if reinforced 
with alcoholic stimulants, will increase the fat and casein, but will 
diminish the sugar. If the mother's milk is evidently disagreeing 
with the nursing infant, a chemical analysis of it should be made, and 
on the result rules regulating the diet should be adopted. The most 
common mistake in practice is to over-feed a nursing woman, espe- 
cially with a milk diet, with the idea which prevails extensively among 
the laity that the cow's milk poured into the stomach appears again 
in the mammary gland. It is usually sufficient for a nursing woman 
to observe the ordinary diet which agrees with her under all circum- 
stances, with the addition perhaps of a half-pint of milk midway 
between the morning and mid-day and mid-day and evening meals. 
Occasionally a wineglassful of malt at the mid-day and evening meals 
is a useful addition to the diet, and in anaemic patients the addition 
to the malt of 5 grains (0.3) of pyrophosphate of iron will be an 
advantage. 

There is found in every pregnant woman some alteration in the 
constitution of the blood, which consists, roughly speaking, of a dimi- 
nution of the red blood-corpuscles and of the albumin and the iron 
in the blood, with an increase in the white blood-corpuscles and the 
watery element. In some cases this change is much exaggerated, 
until an intense degree of anaemia appears in the puerperal state 
which, in its severity, will simulate pernicious anaemia or some fatal 
form of blood disease. The anaemia of puerperal women, however, 
even in exaggerated cases, usually yields to treatment in a most 
gratifying manner. After the prolonged use of Blaud's pills the 



620 DISEASES. 

writer has seen the blood-corpuscles rise from less than three to 
nearly four and a half millions, and the haemoglobin increase from 
40 to 75 per cent, in a few weeks. In some cases arsenic alone suc- 
ceeds where iron fails completely. 

Eclampsia. 

To treat eclampsia intelligently and successfully it is necessary to 
understand its etiology as fully as modern knowledge permits. Al- 
though the subject needs more light from future investigations, enough 
is now known to justify the following statement: 

1. The cell-activity of mother and foetus produces excrementitious 
substances which will surely prove virulently poisonous to the whole 
organism unless they are voided or made harmless by the excretory 
organs. 1 

2. The organs in the childbearing woman are often inadequate to 
the disposal of effete material from the maternal and foetal bodies. 

3. Consequently, poisons, of a nature not yet demonstrated, are 
stored up in the maternal blood until, by cumulative action, their 
presence is manifested in the eclamptic seizure and other symptoms. 

4. The convulsions are probably the result of an acute cerebral 
anaemia brought about by violent contraction of the arterioles, pos- 
sibly by direct irritation of the brain-substance. As a result of 
intense muscular action the circulation is interfered with, and blood 
is determined to non-m oscular regions, as the brain, lungs, kidneys, 
etc., to such a degree that the congestion of these parts become dan- 
gerous, leading to apoplexy in the brain, oedema in the lungs, and 
often a complete abrogation of renal function. 

The indications for treatment in convulsive seizures of this nature 
are plain : 

First, to attack the fons et origo mali, and to eliminate the poisons 
from the blood as quickly and in as large quantities as possible. 
Second, to diminish nervous sensibility and lessen muscular power, 
in order to reduce the convulsions in vehemence, duration, and fre- 
quency. Third, if convulsions occur during labor, to save the infant 
without adding to the risk of the mother. Fourth, to guard the 
woman from injury during the attack. 

The first indication is met by venesection, diaphoresis, and cathar- 
sis. By the first, one eliminates a certain quantity of poison along 
with the blood and relaxes the muscles. If there is sharp post- 
partum hemorrhage, or if the patient is from any cause weak and 
anaemic, bloodletting is not called for. In the ordinary case, how- 
ever, with full pulse, congested head, the veins standing out upon the 
neck and face, venesection is an undoubted advantage. While the 
median basilic of one or both arms is being opened some croton oil 
should be sent for, and 2 drops (0.1) mixed with sweet oil may be 
placed upon the tongue. Directions should at the same time be given 
to wring out three or, better, four old blankets in boiling water; these 
are to be wrapped around the legs, trunk, and arms, and well covered 
1 Harold C. Ernst, American System, of Obstetrics, vol. ii. p. 431. 



REMITTENT FEVER. 621 

over with one or more dry blankets. The sweating thus induced is 
profuse. An ice-bag must be put to the head to prevent over-con- 
gestion of the brain. In this way one eliminates the cause of eclamp- 
tic convulsions as quickly and thoroughly as possible from the blood, 
directly and indirectly through the skin and bowels. The latter may 
be acted upon by J grain of elaterium rubbed up in butter, or by 
compound jalap powder and calomel, instead of resorting to the croton 
oil. Pilocarpine seemed at one time an ideal remedy to secure diaph- 
oresis in eclamptic cases, but it has lately fallen into well-deserved 
disrepute. It much increases the danger of pulmonary oedema, and 
is too profound a depressant. It is no longer employed by experienced 
and educated obstetricians. The second indication is best met by an 
anaesthetic. Usually the convulsion first shows its approach in the 
eyes : these should be closely watched, so that on the first symptom 
of the oncoming attack chloroform may be at once administered and 
pushed as rapidly as possible. Ether is inadmissible in these cases, 
for it is slow of action, congests the brain, and irritates the kidneys, 
Just before the woman is wrapped in blankets 1 drachm (4.0) each of 
chloral and bromide of potassium in starch-water should be injected 
into the rectum. This may be repeated in an hour if necessary. 
Morphine, veratrum viride, and inhalations of nitrite of amyl have 
their enthusiastic advocates in this connection. They may be held 
in reserve in case the plan of treatment described needs reinforce- 
ment. 

If convulsions come on during labor, the child should be rapidly 
extracted as soon as the os is well dilated, but not before, because 
efforts to dilate the os would be very apt to increase the convulsions, 
and would attract the physician's attention from the Avoman's most 
threatening danger. Moreover, the os dilates naturally with unusual 
rapidity during eclampsia. 

The only injury to be feared during eclamptic attacks is wounds 
of the tongue from the teeth. This can be prevented by inserting 
between the teeth a brush-handle wrapped in a handkerchief or by 
drawing a towel into the mouth like a bit. Well-meaning but igno- 
rant bystanders will sometimes throw themselves upon an eclamptic 
patient to restrain her convulsions by force. This should be forbidden. 



REMITTENT FEVER. 

This is sometimes called bilious fever by reason of the violent 
bilious vomiting and jaundice which often accompany it. It separates 
itself from intermittent fever by the fact that the patient's condition, 
chiefly as regards temperature, does not have normal intervals, but 
has periods of only temporary improvement, or, in other words, the 
disease remits. 

For the proper treatment of this fever, three things must be borne 
in mind : 1. It is more dangerous than intermittent fever ; 2. It is 
dangerous in the hot stage, not in the cold stage ; 3. The patient, 
not having periods for complete or partial recovery, rapidly loses 



622 DISEASES. 

strength. The safety of the patient depends upon the use of large 
doses of quinine to cut short the pyrexial stage, the doses used being 
from 20 to 30 grains (1.3-2.0), preceded by a good-sized purgative 
dose of calomel, say 3 to 4 grains (0.15-0.2). If vomiting is too vio- 
lent to permit of the retention of the quinine, it must be used by the 
rectum and hypodermically, and the stomach and intestines be swept 
out by the use of divided doses of Seidlitz powder or citrate or sul- 
phate of magnesium. If purgatives are used, they should precede 
the quinine by twenty minutes, as otherwise the latter drug is swept 
out into the bowels, where it is rendered useless by reason of its pre- 
cipitation by the alkaline juices there present. Many clinicians claim 
that remittent fever is chiefly benefited by quinine during the remis- 
sion, and cinchonism during the pyrexial stage undoubtedly increases 
the discomfort of the patient. If pyrexia is excessive, relief must be 
sought in the cold pack and antipyrine. 

The best treatment of the vomiting is the use of small doses of 
morphine, or 3- to 5-drop (0.15-0.3) doses of the spirit of chloro- 
form in from 30 drops to 1 drachm (2.0-4.0) of cherry-laurel water. 
Aconite may also be used if the patient is strong enough. (See 
Vomiting.) 

If the belly is tender, a turpentine stupe should be applied. (See 
Turpentine.) 

If intestinal hemorrhages occur, gallic and tannic acids or Mon- 
sel's salt, in the dose of 3 grains (0.15) in hard pills, may be used, 
and cold cloths be placed over the belly. (See Hemorrhage.) 

If haematuria appears, quinine must be avoided unless the neces- 
sity for its employment is absolute because of the frequent recur- 
rence of paroxysms. Quinine in some cases increases the haema- 
turia. (See Collective Investigation bv author in Tlierapeutic Gazette, 
July, 1892.) 

The treatment of convalescence consists in the use of tonics, such 
as quassia, calumba, gentian, Huxham's tincture, arsenic, and purga- 
tives when needed, with attention to the kidneys, the potassium salts 
being employed to keep these organs active. (See Intermittent Fever.) 



RETINITIS. 

Retinitis, or inflammation of the retina, often associated with cho- 
roiditis, is commonly the result of several constitutional diseases : 
Bright's disease, diabetes, syphilis, etc. In some cases no cause can 
be found. The general remedies must be directed according to the 
supposed cause, and the eyes must be protected from light and all 
close work avoided. Very distinct retinal irritation may be caused 
by eye-strain, which is to be relieved by the prolonged use of atro- 
pine and dark glasses, and later suitable lenses for the correction of 
any existing error in refraction. 



RHE UMA TISM. (523 



RHEUMATISM (ACUTE ARTICULAR). 

No better example of the fact that therapeutics is in advance of 
pathology can be adduced than the disease known as rheumatism. 
The therapeutist cannot tell how he cures the condition designated 
by this name, simply because the pathologist cannot tell what the 
cause of the disease is, and when this information is forthcoming 
from the one side, an explanation will be immediately given by the 
other. This being the case, we must devote ourselves to the study 
of pure empiricism, and not to logical pharmacology. 

The treatment of acute articular rheumatism is divided into that 
portion devoted to the cure of the disease-process, and that directed 
to the relief of the pain and of the local manifestations of the 
disease. 

When an acute attack of rheumatism comes on, it is nearly always 
accompanied by a high temperature, a bounding pulse, and all the 
evidences of active systemic disturbance accompanying inflammatory 
outbreaks, which, in this particular instance, involve the joints. We 
may therefore use at such times the remedies which we have learned 
are best able to combat inflammation — namely, aconite and veratrum 
viride. So powerful are these drugs in the early stages of acute 
rheumatism that some persons have believed them to be possessed of 
a specific antirheumatic power. This is, hoAvever, highly unlikely, 
as they act no better here than in other inflammatory conditions else- 
where. 

The proper manner in which to use the tincture of aconite under 
these circumstances, in a strong, healthy individual, is to administer 
3 drops (0.15) at once in a little water, and follow it by a teaspoonful 
of a mixture containing 5 drops (0.3) of tincture of aconite and 2 
ounces (64.0) of water, every half-hour until perspiration on the skin 
betokens circulatory depression through the action of the drug. If 
this is not used, veratrum viride in the same proportions may be 
given. The advantages of this treatment are numerous; first, it allays 
the fever; second, it quiets nervous excitability; third, it tends to 
prevent permanent changes in the joints which are involved; and, 
last of all, it aids in the production of a sweat. Whenever these 
drugs are employed the patient must be strong and hearty, not debil- 
itated or weak, and it is to be noted that this treatment is not to be 
resorted to carelessly. Finally, care is to be taken that the symp- 
toms of depression from the drug and the disease combined do not 
become too severe. Where great exhaustion is primarily present or 
ensues upon the use of depressant drugs, alcoholic stimulants are 
particularly needed. 

Simultaneously with these internal measures a solution of bicar- 
bonate of sodium, 20 grains to the ounce (1.3 : 32.0), may be applied 
to the joints involved, by means of lint wet with this solution, with 
relief to the sense of heat or burning, or ice-cold compresses may be 
tried. In other cases relief may be obtained by applying hot cloths 
saturated with the so-called Fuller's lotion — namely, carbonate of 
sodium 6 drachms (21.0), laudanum 10 ounces (320.0), glycerin 2 



624 DISEASES. 

ounces (64.0), and water 9 ounces (288.0). Sometimes great relief 
is obtained by fixation of the joints by means of splints. 

A most valuable application to the inflamed joints of rheumatism, 
either during the acute stage or afterward when they remain swollen 
and enlarged, is : 

R.— Ichthyol £iv vel ,$j (16.0-32.0). 

Adipis §ij (64.0). — M. 

S. — Rub in well and apply about the inflamed part on lint. 

In other cases the acute stages of the inflammation may be com- 
bated with advantage, particularly where there is gastric disorder, by 
the local application of salicylic acid made into an ointment with an 
animal fat, not vaseline or glycerin, as it is not absorbed when so 
mixed. According to Bourget, this treatment is best suited to blondes 
and young persons, as absorption is more rapid in this class of 
patients. The following salve maybe prescribed: 

R.— Acid, salicylic 3j (4.0). 

01. terebinthin ff\,xxx (2.0). 

Lanolin 5J (32.0).— M. 

High fever is to be controlled by the same measures as the high 
fever of any other disease — by antipyretics, by the cold pack, cold 
bath, or sponging with tepid or cold water. 

Immediately after the system has been thoroughly impressed by 
cardiac sedatives — or at once and in their place if the case is not 
seen at first or is weak — the physician should resort to one of three 
remedies — namely, salicylic acid or its salts, antipyrine, or acetanilid. 
The general opinion of the profession seems to be that these three 
remedies stand in the order here placed in regard to their efficiency, 
but it is also true that one will often succeed when the other fails, 
and it is worthy of note that success or failure generally asserts itself 
rapidly; that is, the drug used gives relief in twenty-four or seventy- 
two hours or fails altogether. It is most important to remember 
that salicylic acid only protects the cardiac valves and the entire 
endocardium from the ravages of the disease by shortening the attack, 
and not by any direct influence, and in addition that this acid, by 
reason of the profuse sweats often produced by it and its tendency to 
cause cardiac depression, must be watched lest it act unfavorably on 
the general systemic state. 

Taking up salicylic acid first, we find that its proper use is often 
misunderstood, and that it fails because of this fact. Whenever acute 
articular rheumatism appears the salicylic acid should be pushed in 
the same way that we use quinine on the advent of a malarial parox- 
ysm — namely, in full dose. 

It is useless to give salicylates in 5- or 10-grain (0.3-0.65) doses 
three times a day ; they must be given in 20-grain (1.3) doses, morn- 
ing, noon, and night, or oftener, or not at all. If the sweats are 
too severe or the stomach rebels, they may be stopped, but not 
decreased in amount unless for good reason. Further than this, if 
salicylic acid is used for two or three days in this way, and produces 
evidences of cinchonism, yet fails to alter materially the course or 



RHEUMATISM. 625 

severity of the trouble, it should be withdrawn, as it will rarely if 
ever do any good after this time. 

A very efficient substitute for salicylic acid is the oil of gaultheria 
(wintergreen), which contains about 90 per cent, of salicylate of 
methyl. The dose should be 10 to 20 drops (0.65-1.3) on a tea- 
spoonful of sugar or in capsule or emulsion three times a day, after 
meals. 

Antipyrine and acetanilid may both be considered together, since 
their action is identical in rheumatism. The author believes that 
antipyrine, while often relieving the pain more than the acetanilid, 
nevertheless does not act so favorably in decreasing the duration of 
the disease. The dose of the first should be 5 to 10 grains (0.3-0.65) 
three times a day ; of the second, 4 to 8 grains (0.2-0.6) at the same 
intervals. 

The studies of Guttmann with acetanilid in a very large number 
of cases of rheumatism, embracing all its forms, both chronic and 
acute, have given most encouraging results, and the author has seen 
the drug act most happily in cases which had refused to yield to 
the iodides and salicylates, although all of these cases were of the 
severe acute form, suffering intense pain from the articular inflamma- 
tion, but devoid of any cardiac complications. It at once becomes 
evident that a drug such as antipyrine or acetanilid may do good in 
a case of rheumatism in three entirely separate and distinct ways, any 
one of which may be active at once or all active together, hand in 
hand, in the improvement of the patient's state. Any substance pos- 
sessing strong antipyretic power must be of value under such circum- 
stances, because of the lowering of the fever which follows its admin- 
istration, with the resulting quieting of an excited system, and in 
putting aside the delirium associated with a condition of hyperpy- 
rexia. Not only does such a drug act favorably in this manner, but 
the analgesic effects of such a substance must exert a powerful influ- 
ence for good. By benumbing the sensibility of the patient to the 
excruciating pain consequent upon movement, and so putting aside 
the nervous wear and tear of sleeplessness and suffering, the patient's 
state must be improved, or at least not grow worse from the exhaus- 
tion of the long hours of agony. Further than this, it would seem 
probable that acetanilid possesses a direct antirheumatic influence, 
allaying the disease-processes even in those forms where, pain being 
largely absent, the improvement must be real and not apparent. 

The intention of the author is not to extol the value of acetanilid 
and antipyrine in rheumatism to the exclusion of other means of re- 
lief, nor to recommend their use before the more thoroughly tried sali- 
cylates and iodides, but to draw to their standard a certain number of 
cases which persistently resist treatment of the ordinary stamp, and 
which put the physician to his wit's end for a change of treatment at 
least promising some chance of relief. Many of the readers of this 
book have doubtless seen such cases, and many of them must have 
learned by sad experience that acute articular rheumatism is in many 
cases bound to run a course of so many weeks or days, do what we 
will. Under these circumstances nothing acts further than a pal- 

40 



626 DISEASES. 

liative, and the patient and his friends become impatient for a change. 
The author has found that acetanilid in such cases will often relieve 
the pain, and so permit a refreshing sleep, in doses of from 4 to 8 
grains (0.2-0.6) three times a day, and that these amounts do not 
cause the excessive sweating which the necessarily large doses of 
salicylate are sure to produce — sweats which leave the patient often- 
times almost dyspnoeic from very weakness. Whether this temporary 
relief produces such changes in the system as to permit of a better 
battle against the disease, or whether it actually counteracts the rheu- 
matic poison, we know not ; but we do know that after the use of ace- 
tanilid the relief is not only temporary, but often permanent, and 
that a very distinct step in advance is made toward the close of the 
attack if any influence at all is felt. 

The following prescription, which is of additional value because 
the caffeine supports the heart and increases urinary secretion, is 
recommended : 

R.— Acetanilid '. gr. xl (2.6). 

Caffein gr. xx (1.3). 

Camphor, monobromat gr. xx (1.3). — M. 

Ft. in capsul. vel pil. No. xx. 
S. — One every three hours or three times a day. 

Phenacetin is often very useful when used in rheumatism, partic- 
ularly if combined with salol. 

Passing from what may be appropriately called the coal-tar treat- 
ment of rheumatism, because all the drugs so far named for internal 
use have such a source, we come to a list of remedies heretofore 
largely used in rheumatism in place of the newer compounds, but 
which are not so commonly employed to-day. 

These remedies act, as a rule, in the subacute forms of rheumatism 
or in the cases where the first group fail because the disease is obsti- 
nate. Of these the chief is the iodide of potassium, followed by the 
acetate, bicarbonate, and citrate of potassium. If the iodide is used, 
the following prescription is of service : 

R.— Potassii iodidi ...-•• • • SJ (32.0). 

Syr. sarsaparilla? comp f^yj (192.0). — M. 

S. — Dessertspoonful (8.0) three times a day, after meals. 

In other cases it is best, because of the disagreeable taste of the 
iodide, to give it in sugar-coated pill or in tablet form, but care should 
be taken that milk or water is taken at the same time to prevent 
gastric irritation. 

Or, if preferred, 20 to 30 grains (1.3-2.0) of the bicarbonate of 
potassium may be taken every four or five hours in water flavored with 
cinnamon for the sake of the taste, or the citrate of potassium, which 
is more agreeable, may be taken in equal amount. Sometimes a little 
colchicum added to the prescription given above may be useful if the 
case is very obstinate, as follows : 

R.— Potassii iodidi .^j vel ^ij (32.0-64.0). 

Vini colehici radicis f.^ij vel f^ss (8.0-16.0). 

Syr. sarsaparillse comp. . q. s. ad f^vj vel fgxij (192.0-384.0). — M. 
S. — Dessertspoonful (8.0) three times a day, after meals. 



RHEUMATISM. 627 

Haig has proved that in rheumatism there is retention of uric acid, 
and that the use of alkalies and the salicylates at once causes this sub- 
stance to be changed into a soluble form ready for elimination. 

The other drugs used in acute rheumatism are numerous, but only 
a few of them deserve attention here. There is abundant evidence 
on record that full doses (10 to 30 drops [0.65-2.0]), of the fluid 
extract of cimicifuga if given every five hours will decrease the red- 
ness and pain of the joints and shorten the attack in some cases. 
Again, certain species of rhus, as rhus toxicodendron, are useful if 
fresh preparations are at hand. The dose of rhus toxicodendron is 
Y 1 ^ to 1 drop (0.006-0.05) of a tincture made by adding 1 part of the 
fresh leaves of poison-ivy to 2 parts of alcohol, this dose being taken 
three times a day. Where the pain seems particularly severe at night 
this drug is very valuable, according to many careful students of 
therapeutics. 

Nearly every case of acute rheumatism will do better if a strong 
mixture of lemon- or lime-juice and water be taken daily in large 
quantities. 

The local remedies in rheumatism are chiefly counter-irritants and 
sedatives. Thus, small or large blisters applied around an inflamed 
joint after the general systemic excitement is passed may be of great 
value in restoring the suppleness of the joint and in aiding in the 
absorption of the effusion. The remaining local treatment consists in 
thoroughly painting the inflamed parts with tincture of iodine if blis- 
ters are not used, and in the application of veratrine ointment or 
iodine ointment around the joint. (See Veratrina.) 

Salol, which is dissolved and absorbed solely in the intestine 
through the action of the juices there present, has been used in the 
place of salicylic acid Avith success ; but it is worthy of note that, as 
it contains 40 per cent, of carbolic acid in addition to the salicylic 
acid, its use in very large amounts is dangerous. (See Salol and 
Salophen.) 

RHEUMATISM (CHRONIC). 

Chronic rheumatism is one of the most difficult and obstinate dis- 
eases with which we have to deal. In some cases the acute form just 
considered merges slowly into the chronic form, or, in other instances, 
the disease gradually comes on, increasing, it may be, by exacerba- 
tions or by gradual progression. The treatment of chronic rheuma- 
tism is somewhat different from that of the more acute forms, and 
approaches that of gout in some of its therapeutical indications. In 
other words, the salicylates are not so useful in these cases as are the 
iodides and colchicum, so that in the majority of instances the pre- 
scription of iodide, sarsaparilla, and colchicum given in the article on 
Acute Rheumatism is indicated. When anaemia or weakness is pres- 
ent, cod-liver oil is often of great service, and it is worthy of note that 
this useful nutritive remedy was first brought into therapeutics by 
the fishwives of Holland, who found it useful in the attacks of rheu- 
matism to which their husbands were subjected through exposure. 



628 DISEASES. 

When the oil is thoroughly rubbed into chronically-inflamed joints 
it is almost as useful as when taken internally. 

The same forms of severe counter-irritation are not so useful in 
chronic rheumatism as in acute rheumatism, but a very valuable 
therapeutic measure in these cases is the use of the Russian or Turk- 
ish bath or an improvised sweat by means of a lamp and a blanket. 
(See Heat, and Cold.) Liniments are always called for, for two 
reasons : First, they relieve pain and do good to the parts, if not 
from their medicinal properties at least by the rubbing which accom- 
panies their application ; second, because they give the patient some- 
thing to do or to have done, and therefore impress him with the 
object-lesson that his attendants are attendant and alive to his suffer- 
ing and need of sympathy and care. 

Among the lower classes the belief in liniments is very widespread, 
and their use will often instil into the minds of the friends a far 
greater confidence than the most logical of treatments with the lini- 
ment left out of the list of remedial measures. 

The following liniments will be found very useful under these 
circumstances : 

R.— Tr, aconiti f^ij (8.0). 

Tr. opii f*j (32.0). 

Olei terebinthinae f|j vel f|ij (32.0-64.0). 

Liniraenti saponis . . . . q. s. ad f^fviij (256.0). — M. 
S. — Poison. Use as a liniment three times a day. 



Or 



R. — Aquse ammonia? fort f^iv (16.0). 

Olei cajuputi fgj (4.0). 

Tr. belladonna? f|j vel f|ij (32.0-64.0). 

Linimenti camphorse . . q. s. ad f^viij (256.0). — M. 
S. — Poison. Use as a liniment. 



Or, 



R.— Tr. opii 

Tr. aconit. \ aa f^iv (16.0). 

Aquse ammon. fort. 

Linimenti chloroformi f^vj (192.0). — M. 

S. — Poison. Use as a liniment to chronically-inflamed muscles or joints. 



In other instances the greatest relief is obtained by employing 
the following ointment of veratrine : 

R. — Veratrinse gr. xxx (1.6). 

Hydrargyri iodidi fiav ^j (4.0). 

Petrolati Jij (64.0).— M. 

S. — Use as an ointment over the joints. 

This ointment ought not to be widely distributed, and the pulse and 
respiration should be watched, as the veratrine may be absorbed and 
depression of a severe character set in. 

For the reduction of enlargements of the joints due to the dis- 
ease, and accompanied in some cases by pain, the following ointment 
is serviceable : 

R.— Unguent, iodi |j (32.0). 

Adipis 3iv vel gj (16.0-32.0).— M. 

S. — Apply locally. 



RICKETS. 629 

Or, still better, 

R.— Ichthyol 31V to gj (16.0-32.0). 

Adipis ; _ Jj (32.0).— M. 

S. — Rub into the joints thoroughly. 

Ichthyol is certainly the most efficient remedy that we have for 
the enlarged and painful joints. 

The employment of red flannel over inflamed joints is no better 
than the use of white flannel, and it is never beneficially " medi- 
cated," as claimed in the stores. The only advantage of red flannel 
is that, as it is dyed, the wool is often better for not being thoroughly 
bleached, and is in larger amount for this reason. The disadvantages 
of red flannel are that it stains the clothes and the possibility of its 
producing irritation of the skin or even systemic effects of an evil 
character. 



RICKETS. 

Rickets may be defined as a state of the body of an infant or" child 
in which there is a deficiency of the normal salts of the bones and 
tissues, with corresponding enlargement of the animal portion of the 
bone, or, in other words, the cartilaginous parts. Generally the term 
is applied solely to designate bony troubles, but every practising 
physician sees cases where the manifestations of rickets are empha- 
sized in gastro-intestinal disorders rather than in bony deformities. 
The chief cause of rickets in children, aside from the presence of any 
disease, such as scrofulosis, is inanition ; that is, non-nutrition of a 
specialized form, or, in other words, bone-salts starvation. This may 
occur after or before birth, and it is quite common to see children, 
born of mothers ill-fed or whose assimilation of salts is defective, with 
soft bones or a distinct tendency to rickety development. 

The treatment of rickets is therefore largely dietetic and devoted 
to the improvement of the food and digestion. No part of the body 
fails in force more than the digestive apparatus in the presence of this 
disease, probably because the alkalinity of the blood is altered, and 
partly because the stomach cannot secrete properly-formed juices from 
imperfectly-nourished glands. 

The medicines to be used in rickets are general tonics, digestive 
tonics and stimulants, and bone tonics and stimulants, such as salts 
of lime and phosphorus. The general tonics are quinine, cod-liver 
oil, nux vomica, and iron, while the digestive tonics are the simple 
bitters, physostigma, and mineral acids. The bone tonics and stim- 
ulants are lime salts, phosphorus, and phosphate of zinc. 

Tonic treatment is best carried out in young children by the admin- 
istration of quinine in the form of quinine chocolates or by the use 
of strychnine in the dose of yot to TOT °^ a g ra ^ n (0.0003-0.0006) 
in sugar-coated pink granules. Arsenite of copper in the dose of 
yJq of a grain (0.0006) in tablet triturate three times a day is also 
useful : 



630 DISEASES. 



A very useful preparation is the following : 



R.— Olei morrhuse f^vj (24.0). 

?i r ;2 1 l 8 ,i Ct0ph08phat -} aaf 3 iij(96.0).-M. 



Liquor calcis 
S. — j to 1 teaspoonful (2.0-4.0) two or three times a day. Shake thoroughly. 

Nux vomica is so bitter as to be difficult of administration to young 
children, and when given only -J- to J of a drop (0.008-0.016) of the 
tincture should be used, three times a day. 

Where a distinct scrofulous tendency exists and anaemia is present 
small doses of the syrup of the iodide of iron are of service, and -^ 
to 1 drop (0.006-0.05) may be given three or four times a day to a 
child of six months or a year, thus : 

R. — Syrupi ferri iodidi gtt. iij vel xxiv (0.15-1.5). 

Aqua* dest q. s. ad f^iij (96.0).— M. 

S. — Teaspoonful (4.0) every four or five hours during the day. 



Or, 



R. — Syrupi ferri iodidi gtt, v vel xx (0.3-1.3). 

Syrupi # q. s. ad fgiij (96.0).— M. 

S. — Teaspoonful (4.0) three times a day, after meals. 



Here, again, arsenite of copper is a particularly valuable remedy. 

The salts of lime and sodium are of direct benefit to the bones, 
forming by their presence in health a large proportion of the osseous 
system, and therefore they may be considered as foods rather than 
drugs. Very often their administration to nursing mothers or preg- 
nant women saves the maternal teeth from caries and preserves the 
general health of the mother and child. The following prescription 
may be used : 

R. — Syrupi ealcis lactophosphatis f^iv (128.0). 

S. — ^ to 1 teaspoonful (2.0-4.0) three times a day, after meals. 

The reasons for the use of phosphorus are clear, from what has 
been said of that drug when speaking of it elsewhere in this book, as 
it acts as a direct and powerful stimulant of bone-growth. 

Phosphorus is best given to children in the form of very small 
sugar-coated pills (-g-J-g- gr. [0.0003]), such as are put up in the form 
known as " pink granules " by manufacturing chemists. 

Phosphate of lime and phosphate of sodium are valuable remedies 
in rhachitis. They are never to be used in large doses, because they 
will not be assimilated and will only disorder the stomach. The 
proper dose of each is 1 to 2 grains (0.05-0.1), placed in the milk, 
where their presence will not be noted. 

The ventilation of the rooms where a child prone to rickets is 
kept should be excellent, not too hot or cold and free from draughts. 
A cool sponge-bath is useful at night if the patient is strong enough, 
or a good rubbing with salt and whiskey, 1 drachm (4.0) of salt to a 
pint of whiskey, is of still greater service. 

Special attention should be paid to the development of the mus- 
cles by massage and passive movements, as these parts are always 
weak. Walking must not be allowed too early, as it may cause 
bony deformities. 



SCARLET FEVER. 631 



SCARLET FEVER. 



This disease, the most frequently fatal of all the exanthematous 
diseases of childhood, requires the greatest care in its treatment. 
Complications constantly arise requiring skill on the part of the 
attendant, and it is upon his success in treating these outbreaks, as 
well as in the general direction of the case, that the life of the patient 
chiefly depends. It has been claimed by certain practitioners that 
one or two remedies which they have used act as abortifacients of 
the attack, decreasing its severity, duration, and the probability of 
complications. Thus, one European physician has used salicylates 
with w T onderful results, if his claims are true, for he found them to 
prevent all complications and even to remove them when present. 
He gives, throughout the entire attack and for some days after defer- 
vescence has ensued, the following : 

R. — Sodii salicylat gr. xlviij (3.0). 

Aquse destillat ... fzij (8.0). 

Syr. aurantii q. s. ad f^iij (96.0). — M. 

S. — Teaspoonful (4.0) every hour during the day and every two or three hours at 
night, in a little water. 

In this country Wilson has employed chloral throughout the entire 
attack, with asserted good results, in the following manner ; but in 
our opinion Wilson's method is not the best for most cases, unless 
the nervous manifestations are very marked, when the chloral treat- 
ment is of great value. 

The plan is as follows : " As soon as the patient is suspected or 
known to be developing scarlatina, a laxative dose of calomel, pro- 
portionate to the age and general condition, is administered. Shortly 
thereafter chloral is given in moderate doses, at intervals of two or 
three hours or longer, throughout the attack. The dose varies with 
the age of the child ; the frequency of its administration depends 
largely upon its effect. To infants of two or three years a dose of 
from 1 to 2 grains (0.05-0.1) may be given, the dosage being grad- 
ually increased with older children, that for adolescents reaching 5 
grains (0.3). The tranquillizing and sleep-producing effects of the 
drug are, in most instances, promptly realized, the patient falling into 
a condition of quietude, instead of the restlessness and jactitation 
which are so distressing in the well-developed forms of the disease. 

Ct The repetition of the dose should not be more frequent than is 
necessary to maintain this condition of quietude — a condition from 
which the patient may be easily aroused, and into which he quickly 
relapses when left undisturbed. It is neither necessary nor desirable 
to push the drug to the establishment of a deeper sleep. Profound 
narcotism is, of course, to be avoided. The patient may thus be 
kept in a condition of light repose throughout the whole duration of 
the fever. By this means not only is there obtained relief from the 
restlessness and distress of the active period of disease, but much 
wear and tear of the nervous system and some exhaustion from mus- 
cular effort are prevented. Delirium is controlled ; the itching and 
burning of the skin, due to the eruption, are allayed ; in a word, the 



632 DISEASES. 

greater number of the distressing symptoms of the disease are favor- 
ably influenced by the cautious and prolonged administration of chloral 
hydrate in efficient doses." 

As a rule, the drug is easy of administration and well borne by 
the stomach. Its acrid after-taste is best masked by its administra- 
tion in Aubergier's syrup of lactucarium, diluted, thus : 

R. — Chloralis •. gr. xxx (2.0). 

Syrup, lactucarii (Aubergier) | f?gg ye] fJ . (16 _ 32 .o)._M. 

AQU86 J 

S. — A teaspoonfal (4.0) in iced water every two, three, or four hours. 

" The administration of nourishment immediately after the medi- 
cine is desirable. The sleep-inducing properties of the drug manifest 
themselves rapidly, but are not prolonged ; therefore its repetition at 
intervals of two or three hours is called for." 

From the very beginning of an attack to its end unless diabetes 
comes on, the child should be supplied with plenty of pure water, 
and, if possible, this water should be obtained from a spring contain- 
ing a low percentage of solids, as Poland water, which is widely sold 
throughout this country. If this is impossible, then Vichy water may 
be employed, or it may be used by obtaining the granulated Vichy 
salts sold by most large drug firms, and adding this in small amounts 
to pure filtered or distilled water. This makes an effervescing draught 
which may be taken while bubbling or not as the child desires. The 
object of this treatment is to flush out the kidneys, and to so dilute 
the effete matters generated in the body by the fever and the germs 
of the disease that they lose, to a great extent at least, their poison- 
ous and irritating powers. 

In other cases a prescription containing sw T eet spirit of nitre and 
citrate of potassium proves useful, as follows : 

R.— Spt. sether. nitros . . . f 5j (32.0). 

Potassii citratis ,^ij (8.0). 

Aqua- q. s. ad fgvj (192.0).— M. 

S. — Teaspoonful (4.0) every two hoars if the urine is high-colored. 

The convulsions which sometimes usher in an attack are to be 
treated by 5-grain (0.3) doses of chloral and 10 to 20 grains (0.65-1.3) 
of bromide of sodium for a child of five to eight years. The convul- 
sions of the advanced stages are often uraemic, and must be treated 
appropriately. 

The further treatment of the disease rests upon the symptoms 
alone. We cannot cure the patient by the use of remedies, but we 
can do much toward making the pathway to health smooth and free 
from pitfalls and obstructions. 

Probably the most common complications calling for treatment, 
when the kidneys have been treated in the way just spoken of, are 
high temperature or fever, and sore throat or angina. The fever is 
to be controlled in these cases in precisely the same way that it is in 
all other conditions in which it is present. It is best to attempt to 
keep it down below 101°' or at least below 102° F., by tepid spong- 
ing, which also allays the itching of the skin, or, if the fever still 



SCARLET FEVER. 633 

rises, by the use of colder water, or even the cold pack if the parents 
will allow it. Generally the popular fear that the application of cold 
to the surface will drive the eruption "inward" is so strong as to 
make the cold pack objectionable in the eyes of the friends; but if 
the temperature reaches 105° F., the physician must assert the fallacy 
of this belief and insist on its use. (See Cold, Part III.) If sup- 
pression of the rash does occur, we must use the wet pack. (See Heat, 
Part III.) Antipyrine and acetanilid, to be sure, may both be used, 
but it is worthy of note that each of these may produce collapse or 
other complication if large doses are necessitated by an obstinately 
high temperature. If these complications ensue, alcohol will be indi- 
cated. Quinine has been highly recommended as an antipyretic in 
scarlet fever, but it is of little value in the majority of cases, simply 
disordering the stomach and irritating the kidneys if used in doses 
large enough to be effective. Where the head seems to be particu- 
larly hot and the fever is high, an ice-bag or a head-coil of rubber 
tubing is to be employed, and through the latter water may be circu- 
lated at whatever temperature is thought best. (See Cold, Part III.) 

The treatment of the sore throat of scarlet fever is an important 
part of the care of the child in many cases. Small pellets of ice 
may be held in the mouth and an ice-bag applied to the outside of 
the throat. This is done by finely breaking up some ice and placing 
it in a thin india-rubber bag about the neck, the surface of the bag 
being covered by a cloth to prevent too rapid melting of the ice and 
the wetting of the clothes by the condensation of moisture on the 
surface of the bag. This treatment should be used during the entire 
attack if needed, and the contents of the bag renewed as often as 
the water becomes at all warm from the heat of the body. By this 
means the redness of the fauces and the swelling of the glands of 
the neck are prevented or relieved. Chlorate of potassium may be 
used in a spray or on a swab, but never internally, oAving to its irri- 
tant effects upon the kidneys and stomach and its general influence on 
the blood. 

In some cases where the eruption fades or is never very prominent 
it is of the greatest importance that it be made active. Under these 
circumstances the child may be placed in the warm wet pack, and, if 
the head is very hot, cold applied to the vertex and throat while the 
body is enveloped in the blanket. (See Heat.) This often brings out 
in an hour or two a bright scarlet rash, and the child falls asleep and 
wakes up free from delirium and high fever. 

The itching and burning of the skin in many cases of scarlet fever 
are annoying symptoms, and they may become really dangerous. The 
author has recently carried out a series of experiments showing that 
fever of high degree can be brought on solely through nervous irri- 
tation, thus explaining a fact long well known to clinicians — namely, 
that the relief of this dermal irritation in scarlet fever may be fol- 
lowed by a fall of temperature. To relieve this symptom it will often 
be found advisable to cover the entire skin with a thin layer of vase- 
line or cosmoline or benzoated lard, or, in other cases, as an antisep- 
tic and local anaesthetic, carbolized oil may be applied (2 drops of 



634 DISEASES. 

carbolic acid to each 2 ounces [0.1 : 64.0] of olive oil). In other 
cases almond oil may be used. 

If nephritis comes on and is a pressing condition, the greatest 
care is necessary, and the object of the physician must be to make 
the skin, disabled as it is, carry out a sufficiently active eliminative 
function to relieve the kidneys of any strain, to remove dropsy, and 
to aid in the removal of effete matter by producing catharsis. These 
effects are best attained by the use of pilocarpine: ^ grain (0.01) by 
the mouth for a child of ten years, or -^ grain (0.006) hypodermi- 
cally. If cardiac weakness exists, this drug cannot be given, and we 
are forced to the use of from 5 to 10 grains (0.3-0.65) of compound 
jalap powder to a child of ten or twelve years, to which should be 
added 10 grains (0.65) of bitartrate of potassium to increase its 
efficiency. Sweating may also be produced by the employment of 
heat obtained by the use of bottles of hot water or hot bricks placed 
about the patient, who is first wrapped in blankets, so that the bottles 
cannot burn the skin, and so arranged that sweating will come on. 
The thermometer must be placed in the mouth to foretell any danger 
from heat-stroke if the sweat should fail to appear. In such cases 
the hot pack is of great value. (See Heat.) 

The after-treatment of scarlet fever during convalescence consists 
in the use of Basham's mixture or the tincture of the chloride of iron 
and in the employment of simple bitters, strychnine, or quinine. 
Fresh air, sea-air or mountain-air is useful, while cold or exposure 
to cold air or draughts is to be carefully guarded against. 



SCIATICA. 

Sciatica is an exceedingly obstinate affection, in the majority of 
cases resisting the best treatment for weeks. It seems to be due to 
rheumatic taint in the majority of instances, and may sometimes be 
cured by the remedies used and described under the heading of Acute 
or Chronic Rheumatism. In other instances it is due to injury or 
jarring of the nerve, as by heavy persons stepping off from a high 
step to the hard ground. Thus the most obstinate case ever seen by 
the writer was one in which a stout man weighing about two hundred 
and fifty pounds acted as "coupler" on a switching engine, and, 
though wonderfully agile for his weight, provoked the disease in the 
leg on which he always first struck the ground when jumping from 
the platform of the moving locomotive. 

The treatment for all cases is both internal and external. The 
internal treatment may be the same as that already described under 
Acute or Chronic Rheumatism, or in other instances consists in the 
use of large doses of bitartrate or citrate of potassium, 40 grains 
(3.0) three times a day, in plenty of water to aid in the maintenance 
of free kidney action. At the same time the amount of coffee and 
tea should be cut down as much as possible, and lemonade, strongly 
acid, be taken freely during the day. If the pain is very excessive, 
morphine should be given, or antipyrine or acetanilid may be used. 



SCROFULOSIS. 635 

The local treatment of sciatica is quite various. One of the favor- 
ite methods is to inject deeply into the flesh, just over or about the 
exit of the nerve from the pelvis, 10 to 20 minims (0.65-1.3) of chlo- 
roform, or instead of the chloroform \ to J grain (0.01-0.016) of mor- 
phine, in 30 minims (2.0) of water which has first been distilled and 
sterilized, may be used with equally good results and less danger of 
sloughing. Other physicians prefer acupuncture, the needle being 
driven down until the sheath of the nerve is punctured. Still another 
useful method is to take a strong glass rod with a round, smooth end, 
and, after anointing the skin over the course of the nerve with a little 
ichthyol ointment or lard, to pass the end of the rod back and forth 
over the tender area, using as much pressure as can be borne. By 
this means massage or pressure on the nerve is accomplished. In 
other cases the daily use of an ether or rhigolene spray over the part 
is effective, or kataphoresis may be resorted to. In still others, from 
three to five large wet or dry cups, preferably the wet, may be placed 
along the course of the sciatic nerve with great advantage. In many 
cases absolute rest of the limb, obtained by placing it in splints, has to 
be adhered to before cure can be possible. Hot-water bags should be 
placed continually about the exit of the sciatic nerve from the pelvis. 

The liniments recommended in chronic rheumatism may be tried, 
and cod-liver oil is of service in obstinate cases. Sometimes nerve- 
stretching must be performed before a cure is effected. 



SCLERITIS. 

Scleritis, or inflammation of the sclera, consists in a bluish-red, 
somewhat elevated patch, with implication of the overlying episcleral 
tissue (episcleritis). In the earlier stages pain and photophobia, if 
present, require atropine and boric acid and compresses of hot water; 
later, the infiltration may be subdued with yellow-oxide-of-mercury 
ointment, associated with massage. If the disease spread and impli- 
cate the cornea and iris, the treatment useful in ordinary iritis is in- 
dicated. In stubborn episcleritis, without iritis, which does not yield 
to these measures, eserine, usually accompanied by pilocarpine sweats, 
should be tried, and even the actual cautery has been recommended. 
The disease in many instances is associated with rheumatism, syphilis, 
scrofula, anaemia, and menstrual disorders : these must always receive 
the needed constitutional treatment, especially if iritis or keratitis 
ensue. Scleritis is a disease hard to eradicate and subject to frequent 
relapses. 

SCROFULOSIS. 

Scrofulosis is to be treated by hygienic measures rather than 
drugs — fresh air, residence by the seaside, proper out-door exercise, 
massage, and dietetics, all of which take precedence of medicines. 

If these necessary adjuncts to a cure are obtainable, the prognosis 
is fair, to sav the least, and the following drugs may be used, all of 



636 DISEASES. 

them being devoted to the improvement of the general health, and 
not to any direct influence over the scrofulous tendency in itself. It 
is hardly necessary to state that cod-liver oil (or its supposed active 
principles combined under the name of morrhuol) is perhaps the best 
remedy of all. The oil should be given in emulsion, being first pan- 
creatized and so prepared as to be somewhat palatable by the addition 
of flavoring substances if the child is old enough to appreciate such 
flavors. In young children, while distaste to the oil is often shown at 
first, a liking for it rapidly develops, so that the writer has seen chil- 
dren cry for it when the oil was discontinued. It is nearly always 
best to combine the lactophosphates or the hypophosphites with the 
oil when it is given in these cases. Whenever anaemia is present, 
syrup of the iodide of iron is useful in from 1- to 10-drop (0.05-0.65) 
doses, according to the age of the child, as follows : 

R.— Syrupi ferri iodidi f&ss vel f^ij (2.0-8.0). 

Aquae dest q. s. adfjiij (96.0). — M. 

S. — Teaspoonful (4.0) in water three times a day, after meals, to a child of one year. 

In these same cases -^ grain (0.001) of arsenous acid or yj-g- 
grain (0.0006) of corrosive sublimate may be given to a child of three 
or four years, in the form of tablet triturates, or the following pre- 
scriptions may be used : 

R. — Liquor potassii arsenitis rr lxvj (1-0)- 

Aqua? destillat fjij (64.0).— M. 

S. — Teaspoonful (4.0) three times a day, after food. 



Or, 



R.— Hvdrarg. clilor. corros. . . gr. X vel gr. I (0.006-0.012). 

Aqua? destillat fgij (64.0).— M. 

S. — Teaspoonful (4.0) every five hours, after food. 



The use of the iodides is generally contraindicated in those cases 
where softening and breaking down of the glands are going on rap- 
idly. In their place we may employ the phosphates of lime or sodium 
in from 1- to 2-grain (0.05-0.1) doses several times a day, and if sup- 
puration is active the sulphurate of calcium, given by placing 1 grain 
(0.05) of it in half a tumblerful of water and giving a teaspoonful 
hourly. This mixture should be made fresh every day to prevent its 
becoming oxidized. 

Where enlargement of the cervical glands takes place, iodine 
ointment, diluted, one-half of lard, should be well rubbed into the 
part twice daily, but stopped at once if any signs of softening or 
fluctuation appear or if the skin becomes reddened. Where these 
enlargements are persistent, ichthyol ointment is to be rubbed in, 
using the following formula: 

R.— Ichthyol ^j vel ij (4.0-8.0). 

Adipis 3j (32.0).— M. 

S. — Apply locally. 

If this is not followed by a cure, the glands should be excised or 
scraped and the cavity packed with iodoform, as in the majority of 
cases these enlargements will be found to be distinctly tuberculous. 
(See Adenitis.) 



SHOCK. 637 



SCURVY. 



Scorbutus is caused so frequently by dietetic lawlessness, and its 
cure is so completely dependent upon the use of proper foods, that 
almost no drugs are to be employed in its treatment. The avoidance 
of all salt meats, or, more important still, the avoidance of those foods, 
be they what they may, which have caused the disease in a given case, 
is to be practised. 

The only remedies particularly indicated are lemon-juice or lime- 
juice or citric acid, the latter being far less valuable in all cases than 
the juice of the fresh fruit. Where lemon-juice causes indigestion 
this effect may be avoided by boiling the lemonade and allowing it to 
cool. The boiling precipitates certain poisonous and irritating albu- 
minoids, and the supernatant liquid when taken away is devoid of 
any evil influence, and may be cooled and sweetened to suit the taste 
of the individual concerned. Arsenic and iron are of service in most 
cases, and rest and quiet are to be insisted upon. 



SHOCK. 

The medical treatment of shock is very important, and the life of 
the patient depends upon the care exercised by the attendant ; but before 
describing the treatment it is in place to consider the causes of the con- 
dition and the state of the injured person, so that Ave may understand 
the methods indicated. Every physiologist recognizes the fact that 
the body, particularly in its most vital parts, is controlled by inhibi- 
tory and accelerator nerves or nerve-cells, w 7 hich govern the functions 
of all organs. Normally these two forces of inhibition and acceleration 
act in such a way as to be perfectly balanced, but abnormally they may 
either of them become excessive and overcome the other. . Further 
than this, we must remember that all conditions of great functional 
activity are ultimately followed by a reaction which amounts to 
depression or exhaustion. 

Shock consists in an over-stimulation of the inhibitory apparatus 
which governs the heart and respiration, ultimately followed by ex- 
haustion of inhibition, so that the pulse and breathing become rapid 
and shallow instead of slow\ Various degrees of shock can be readily 
recognized, and the severity of the condition always depends upon 
the constitution of the individual. Every one has heard a nervous 
woman say, "You frightened me so that my heart stood still," and 
again, a moment later, " Just feel how fast my heart is beating :" and 
we all of us know how any severe and sudden shock causes these 
changes to appear in the pulse to some degree. The same mechanism 
is the cause of shock in railway or other injuries, only it is much 
more severe, owing to the actual injury received and its accompany- 
ing terrors. Many of the readers of this book probably know that 
a violent blow upon the belly-wall just over the solar plexus will 
cause death even in so large an animal as the ox, and every boy has 
had the "breath knocked out of him " by a blow in this region. 



638 DISEASES. 

This period of inhibitory excitement speedily gives place to inhib- 
itory exhaustion, and we have a rapid pulse from inhibitory palsy, 
while through the palsy of the vasomotor system the blood-vessels are 
relaxed and the normal resistance to the heart is taken away. The 
heat beats wildly and fast for the same reason that a locomotive's 
wheels fly round when the track is slippery — or, in other words, nor- 
mal resistance is lost. 

The capillaries in the second stage of shock are dilated, and the 
skin is relaxed, moist, and cold frora excessive dissipation of heat. 
This is the more prolonged stage of the two, but they both need 
active treatment. 

The patient will rarely be seen in the first stage of shock, simply 
because by the time the physician reaches him the second stage will 
have come on. In either event the principal things to be done are 
the administration of -^ to ^ grain (0.001-0.0012) of sulphate or 
atropine hypodermically, and the application of external heat to main- 
tain the bodily temperature, the fall of which is a factor of great 
importance, but generally overlooked in attending to an operation or 
other measures of relief. The use of atropine is peculiarly a triumph 
of experimental therapeutics and rests upon logical deduction. It 
will be remembered that atropine in full dose acts as a depressant to 
the vagus nerve, and, as this nerve is over-active in the first stage, the 
drug acts as a sedative to it. This is, however, a comparatively un- 
important fact, for it is another action of atropine which makes it 
valuable. If the vagus be very much stimulated, a safe dose of atro- 
pine cannot quiet it, but in the second stage, which we most com- 
monly have to treat, a safe dose does not act so much upon the vagus 
as upon the vasomotor system, and by preventing the dilatation of the 
blood-vessels of the body thereby provides blood-paths of normal tone 
and tenseness, which do not hold all the blood in stagnant pools where 
it is not needed, but carry it to the brain and vital parts. Digitalis is 
a useful adjuvant to atropine in the second stage of shock because of 
its powerful vasomotor and cardiac influence. 20 drops (1.3) of the 
tincture of digitalis should be given hypodermically, and repeated in 
an hour if the pulse does not show the influence of the drug at the 
end of that time. 

The application of heat in the form of hot-water cans, hot bricks 
or bottles, must not be forgotten, care being taken that the patient is 
not burned. (See article on Heat, Part III.) 

In many cases of surgical shock hypodermoclysis of hot saline 
solutions is of the greatest value, particularly if much blood has been 
lost. (See Hypodermoclysis, Part III.) 



SMALLPOX. 

The treatment of smallpox is not specific, simply because it is one 
of those diseases which run a given course and which we cannot 
abort. We can only treat the various symptoms which present them- 
selves, and by the modification of these manifestations prevent com- 



SMALLPOX. 639 

plications and sequelae to some extent. The fever is to be treated as 
is any fever of this class. Often it can be allayed by a mixture con- 
taining tincture of aconite, spirit of nitre, and spirit of Mindererus 
(liquor ammonii acetatis), while the headache or backache may be 
controlled by antipyrine or acetanilid. Mustard plasters are not to 
be used for the backache, as the dermal irritation will increase the 
eruption. Insomnia and restlessness, if excessive, are to be quieted 
by the bromides or chloral, care being taken that the doses of the 
latter are not large enough to depress the heart. It must be remem- 
bered that the time of onset of the secondary fever, the eighth day, 
is one of grave import to the patient. Before its arrival the treat- 
ment of the case must be so managed that strength is saved for this 
strain, and tincture of the chloride of iron, in 5- to 10- (0.3-0.65) or 
even 20-drop (1.3) doses, may be resorted to to give strength to the 
patient and to affect specifically the pysemic fever. The pulse shoald 
be watched, and if it flags brandy and whiskey should be freely but 
wisely used. At the same time nourishment in the shape of eggnog, 
milk punch, or beef tea should be pushed as freely as the digestion 
will allow. 

The peripheral irritation and itching of the eruption are a cause of 
the fever in part, and produce much unrest and nervous irritability. 
The condition of the skin is, therefore, to be looked after, and the pit- 
ting prevented, if possible, by every means in our power, particular 
care being taken to prevent its appearing on the face. One of the 
means which has been recommended to prevent pitting is the use of 
flexible collodion, and another application is glycerite of starch or 
simple cerate applied in a heavy coating. Some physicians recommend 
inserting the tip of a nitrate-of-silver stick into each vesicle as it rup- 
tures, to prevent pitting. All of these measures are futile in most cases, 
and the use of collodion is probably harmful in some instances. The 
best application to use is made up of 4 parts of salicylic acid to 100 
parts of vaseline or cold cream. Sometimes, anointing the entire 
body with sweet oil slightly carbolized (1 : 100) is useful to check 
irritation. 

If the mouth is sore, a mouth-wash of chlorate of potassium and 
water may be used, flavored with a little tincture of myrrh. 

Disinfection, good ventilation, and the avoidance of much light 
are necessary. 



STINGS AND BITES. 

The stings of nearly all small animals depend for their activity 
upon formic acid, and are to be relieved by the use of dilute alkaline 
liquids, or,' better still, by the application of ammonia, or, instead, 
an application of ordinary or flexible collodion may be made, which 
is improved in its action by the addition of 1 part of mercury bichlo- 
ride to 1000 of the collodion, or, if preferred, salicylic acid may be 
added in the proportion of 5 grains to the ounce (0.3 : 32.0). Some- 
times a solution of carbolic acid, 1 : 100 or 1 : 50, when sponged over 



640 DISEASES. 

the parts exposed, not only relieves the itching of mosquito-bites, but 
keeps away the mosquitoes. In other instances the stings are relieved 
and cooled by the use of dilute or pure vinegar. 

In snake-bite the best treatment is that introduced by Weir 
Mitchell and Reichert — namely, the local application of perman- 
ganate of potassium to the part, which should be thoroughly filled 
with the drug, and full doses given hypodermically about the wound, 
the salt being diluted three-fourths with water and followed by full 
doses of alcohol by the mouth. The secret of successful treatment 
consists, however, in the use of a ligature or a cleansing of the wound 
as soon after its reception as possible, thereby preventing the absorp- 
tion of the poison. 

STOMATITIS. 

This annoying affection is most commonly seen in children, and 
is characterized by the appearance on the tip and sides of the tongue, 
lips, and lining membrane of the mouth of small spots which some- 
times have a reddened zone around them, and which result in minute 
or large ulcers. 

The best treatment, if the kidneys are not acutely inflamed, is the 
use of the following prescription, which largely depends for its value 
upon the potassium salt used: 

Be. — Potassii chlorat 3j (4.0). 

Tinct. myrrh gtt xx (1.3). 

Elixir calisayse . - f^iij (96.0).— M. 

S. — Teaspoonful in water every four hours. 

As the chlorate of potassium is eliminated with the saliva, it not 
only does good when taken into the mouth, but is active all the time 
that it is being eliminated. If the stomach is disordered, the same 
preparation may be used as a mouth-wash. Often constipation will 
exist, and it should be removed by salines or by rhubarb in the form 
of the aromatic syrup. Another remedy which is very efficient in 
stomatitis is borax, used as a mouth-wash, in the strength of 10 to 15 
grains to 1 ounce (0.65-1.0 : 32.0) of water and honey, as follows: 

R . — Sodii boratis gr. xxx (2.0). 

Mel. purificati fgiij (12.0). 

Aqufe q. s. ad f^iij (96.0).— M. 

S. — To be used on a swab or as a mouth-wash overy four hours. 

This also may be used internally in adults. 

In many cases peroxide of hydrogen in the proportion of 1 ounce 
(32.0) of a 15-volume solution to 8 ounces (256.0) of water proves a 
valuable mouth-wash. 

If the liver is at fault and is torpid, nitromuriatic acid is useful, 
and when the spots do not readily yield to treatment they may be 
touched with the tip of a stick of silver nitrate, which treatment, 
while it is momentarily painful, is very efficacious. 

Nearly always with this disease in childhood there is considerable 



SUNSTROKE. 641 

fever, vomiting, and wakefulness at night, with fretfulness and crying 
during the day, and total refusal of food, not because hunger is absent, 
but because the food hurts the mouth and is rejected Avith a cry of 
pain as soon as it touches the lips. The food should be very soft 
milk toast for older children, or milk with lime-water in it in large 
amount for infants fed by the bottle. If a child at the breast be 
attacked, the mother's nipple should be carefully washed with boric- 
acid solution after each nursing. A warm foot-bath at night is often 
necessary to produce rest, and 10 drops (0.65) of sweet spirit of nitre 
thoroughly diluted may be given with advantage to a child of one or 
two years. If the irritability of the nervous system is excessive, 
bromide of sodium or potassium in the dose of from 1 to 10 grains 
(0.05-0.65), according to age, three times a day, is of service, and 
may be added to the mixtures already named, or, better still, given 
alone, well diluted with syrup and water. 

After the attack tonics and a carefully selected diet are generally 
necessary. 

STYES. 

Styes consist in a localized inflammation of one of the glands in 
the margin of the lid or the surrounding connective tissue. Before 
suppuration is established abortive treatment may be practised by an 
inunction with a salve of the red or yellow oxide of mercury (2 grains 
to 1 ounce [0.1: 32.0]), by painting the surface with an ethereal 
solution of collodion, or, according to Abadie, by the application of a 
saturated solution of boric acid. Pain may be alleviated with liot 
compresses (water 110° F.), frequently changed, and as soon as pus 
appears incision is necessary. Associated conjunctivitis requires a 
boric-acid solution for its relief. It should be remembered that styes 
indicate ill health, that tonics are indicated, and that they most fre- 
quently appear in the subjects of refractive error. When they tend 
to come in crops the internal use of sulphurate of calcium has been 
recommended. 

SUNSTROKE. 

Sunstroke — or, more correctly speaking, heat-stroke — is an affec- 
tion produced by exposure of the body to any form of high tempera- 
ture, whether the source of heat be the sun, a furnace, or the radiation 
of heat from the earth. For this reason the condition may occur as 
readily at midnight as at mid-day. 

Heat-stroke is to be divided into two classes, in one of which 
excessive exposure to heat upsets the balance of the thermal mechanism 
of the body, so that fever comes on (thermic fever) ; in the other the 
temperature is lowered and forms the condition known as heat- 
exhaustion. x . 

The condition of thermic fever is very frequently seen, while heat- 
exhaustion is rare. 

The danger of thermic fever is that the excessive heat may cause 

41 



642 DISEASES. 

coagulation of the myosin in the heart-muscle and of the protoplasm 
in the brain, and cause death, or that the same result may be reached 
by paralysis of respiration. 

The danger of heat-exhaustion is that death may ensue from col- 
lapse due to a general failure of vital power and the chilling of the 
body. In heat-exhaustion, too, the vascular system is greatly relaxed 
and depressed, and the circulation is at its lowest ebb. 

The treatment of these two states is, of course, radically different. 
When a patient has thermic fever and is brought under the care of 
the physician, the first thing to be done is to loosen the clothing — if 
possible, remove it — at the same time applying cold to the body, and 
particularly to the abdomen, back, and chest. Better still, the man 
should be stripped, laid upon a bed, which must be covered with a 
rubber blanket, and ice-water be applied to the body by means of a 
sponge, or a piece of ice may be laid on the belly, while another piece 
is rubbed over the rest of the body. While this is being done the 
surface of the patient's body must be thoroughly and briskly rubbed 
in order to bring the hot blood to the cooled surface. 

Care should be taken that the temperature, when it once begins 
to fall, does not drop suddenly below the normal and cause collapse. 
If the clinical thermometer in the mouth or rectum shows that the 
temperature has fallen to 100.5° F. or 101° F., the cold application 
should be stopped, and the patient allowed to lie on the bed covered 
with a thin sheet only. The bodily temperature must be constantly 
watched, as it will probably bound up again in a few minutes, and 
require the application of more cold, used with the same care. This 
second rise is due either to the disorder of the nervous mechanism of 
heat-production and dissipation, or to the fact that, while the surface 
of the body is cooled by the ice, the innermost viscera are still in high 
fever and rapidly heat the surface as soon as the ice is taken away. 
Antipyretics have been found to be almost useless in the hyperpyrexia 
of sunstroke, and at their best are not to be relied upon. 

After the fever has been reduced permanently the danger is not all 
passed, and it is the greatest mistake to discharge a patient as cured 
at this time. After two or three days it is very common for a menin- 
gitis to develop, accompanied, it may be, by little or no fever, but 
characterized by violent darting headache, which is made worse on 
lying down or on sudden movement. The treatment of this state 
must be bold, and venesection is the only safe method of obtaining 
relief, although vascular sedatives, such as veratrum viride, may be 
employed. The bleeding should be copious enough to impress the 
circulatory system to some degree, and may be done by opening any 
of the prominent veins in the arm. (See Venesection.) Sometimes a 
violent attack of epistaxis saves the man's life, when it would have 
been lost through the ignorance of his attendant. If life is preserved 
without vascular depletion, secondary changes in the brain may ensue 
and produce hemianopsia, optic atrophy, imbecility, or insanity. 
Quinine, salicylic acid, and similar substances are all contraindicated 
under these circumstances, because of the congestion of the meninges 
to which they predispose by their physiological effcts. 



SYPHILIS. 643 

The treatment of heat-exhaustion consists in the use of heat instead 
of cold, in order to restore the bodily temperature. Just here, how- 
ever, must be uttered a word of warning — namely, that the mere fact 
that the skin is cold does not prove the case to be one of heat-exhaus- 
tion, since a rectal thermometer may show the central or real tem- 
perature of the body to be in a condition of hyperpyrexia. Of course 
such a case should not receive hot, but cold, rectal injections if the 
symptoms require it. 

The bodily heat in heat-exhaustion is to be raised by placing the 
patient in a bath at 105° to 110° F., or by the use of hot bricks or 
bottles, care being taken that they do not burn the patient. The 
bodily temperature should also be watched, lest the other extreme of 
heat be reached. 

Cases of heat-exhaustion are not so apt to have meningitis as are 
cases of sunstroke, but they are generally slow to convalesce, and 
require tonics and careful watching for a long time. Indeed, in many 
instances the system seems to receive a shock from which it takes 
several weeks or months or recover. 



SYPHILIS. 

In so far as the choice of drugs is concerned, the treatment of 
syphilis is exceedingly simple : iodine, iodide of potassium, and mer- 
cury practically represent the only remedial agents which are well 
proved to possess the power of distinctly counteracting the effects of 
the disease. 

In regard to the method of administration and the period of the 
disease in which any or all of these drugs can be given to the best 
advantage there is a wide diversity of opinion. Following the teach- 
ing of Fournier, in this country the practice generally obtains of 
administering mercury on the appearance of the first symptoms of 
the secondary stage of syphilis ; this drug is continued for from 
twelve to eighteen months, and is then followed by a course of iodide 
of potassium continued for from six to twelve months. If after the 
suspension of this treatment for six months no manifestations of dis- 
ease appear, the patient is regarded as cured. Should the disease 
again break out, the iodides are administered in increasing doses, sup- 
plemented by the addition of mercury if necessary. 

Against this treatment, however, there have been many and vigor- 
ous protests. Every syphilographer knows that the disease is fre- 
quently self-limited. Zeissl states that a large number of cases prog- 
ress to spontaneous cure, and that the secondary eruption in such 
cases disappears in from two to eight months, after which time the 
patient is perfectly well, recidivity being far less common than when 
mercury has been employed in the early stages of the disease. The 
treatment by iodides, he thinks, should be commended chiefly after 
the expectant plan : their effect is not so rapid as is that of mercury ; 
they are suitable, however, to all stages of the disease. When the 
symptoms become so urgent that it is no longer safe to depend upon 



644 DISEASES. 

iodides, mercurial inunctions should be employed, the dosage of the 
drug being regulated by its effect upon the symptoms, in all cases the 
minimum quantity necessary to accomplish the result being admin- 
istered. 

We have, then, three methods of treatment proposed, each advo- 
cated by a formidable array of authorities : 

1. The expectant treatment. 

2. The treatment by iodides, followed, if necessary, by mercury. 

3. The continued treatment, beginning with mercury and ending 
with iodides or the combination of the two drugs. 

By the expectant treatment is implied abstinence from all medica- 
tion intended to directly counteract the syphilitic virus : if possible 
the patient should lead an active, out-of-door life, the diet should be 
most carefully regulated, and the treatment should be purely symp- 
tomatic, tonics being administered when required, the sore throat 
being combated by astringent gargles, particularly those containing 
chlorate of potassium or malic acid, together with direct local appli- 
cations, while the eruption on the exposed parts of the body is con- 
trolled by the application of heat. Even in the mildest cases there 
is nothing to be said in favor of this treatment. Where the primary 
lesion is large and persistent ; where the period of secondary incuba- 
tion is less than seven weeks ; where the papular eruption is uni- 
versal, is confluent, and is accompanied by the simultaneous appear- 
ance of mucous patches ; where the lymphatic enlargement is very 
marked and persistent ; and where the disease attacks a depraved con- 
stitution, — the expectant plan offers little hope of accomplishing a 
cure. Here the second and third methods of treatment are absolutely 
indicated. 

By the second plan of treatment the iodides are administered, not 
immediately on the appearance of the secondary eruption, but after 
this has run a course of several weeks and is steadily increasing in 
severity. The iodide of potassium is chosen by preference, beginning 
with the administration of 5 grains (0.3) three times a day, and in- 
creasing steadily 5 grains (0.3) a day until either the constitutional 
effects of the drug are manifested or the symptoms are favorably 
influenced. Should iodism appear, the dose is cut down one-half 
and continued for one or two weeks, after which, if the syphilitic 
lesions are not favorably modified, inunctions of mercury are employed, 
a drachm (4.0) of mercurial ointment being rubbed in every other day. 
The iodide should be continued for from six to twelve months after 
the disappearance of all symptoms, relapses being combated by tem- 
porarily increasing the dose and by a course of mercurial inunctions. 
If after the suspension of the treatment the patient remains free 
from all manifestations of syphilis for two years, he can be fairly 
considered as cured. 

By the third method of treatment — and this is the method most 
commonly accepted in practice — the patient is placed upon mercury 
the moment the early secondary symptoms denote that the primary 
sore was surely syphilitic. Many surgeons begin this treatment from 
the time that the inguinal glands on both sides become characteristic 



SYPHILIS. 645 

in shape and size. Others wait until there is general lymphatic 
involvement, while others believe that the mercury should not be 
administered until roseola appears. 

In regard to the particular preparations of mercury to be em- 
ployed, the protiodide, blue mass, bichloride, and mercury with chalk 
represent the forms usually employed when the drug is administered 
by the stomach. Of these the protiodide is to be preferred, and the 
effort of the surgeon is directed first toward determining what is termed 
the " tonic " dose. With this end in view, ^ grain (0.016) of the 
protiodide of mercury is given, in pill form, three times a day, and 
every second day this quantity is increased by one pill, the patient 
being meanwhile carefully watched. The drug usually manifests its 
physiological effects by griping pains accompanied by two or more 
watery passages from the bowels, or by foetid breath and slight ten- 
derness of the gums. The quantity taken to produce this effect 
represents the extreme limit to which it is safe to push the drug. If 
this dose is continued or increased, the characteristic symptoms of 
mercuric saturation appear. When the surgeon has determined the 
limit to which the drug can be safely pushed, this dose is cut down 
one-half, and in the absence of further complications the patient is 
directed to continue with this dose for eighteen months. If during 
this time local symptoms appear which show that the disease is not 
thoroughly under control, the mercury must again be pushed to the 
full dose, being reduced to the tonic dose as soon as the disappearance 
of specific lesions permits of this. Where comparatively small doses 
of the protiodide produce pain and purging, opium may be added ; in 
this case the breath and the mouth will show when the full effect of 
the medicine is obtained. Manifestations of the disease occurring 
during mercuric treatment must receive local treatment. The surface 
eruption is combated by mercuric ointments and washes and by the 
application of heat. (See Heat.) Mucous patches in the mouth are 
quickly healed by applications of solid nitrate of silver or sulphate 
of copper, 20 per cent, chromic-acid solution, or the acid nitrate of 
mercury. When these patches occur about the genitals, washing with 
1 : 2000 bichloride solution and dusting with calomel and bismuth 
will be found satisfactory. Alopecia is combated by shampooing and 
by the application of strong stimulating lotions containing croton oil 
or tincture of cantharides. 

The intense cephalalgia is combated by -J-grain (0.010) doses of 
calomel, repeated overy two hours. The periostitis yields most read- 
ily to gentle, long-continued mercuric inunction, supplemented by the 
application of pressure bandages. 

When the integrity of any vital organ is threatened there should 
be no hesitation in pushing the mercury treatment, and in supple- 
menting it, if favorable results do not follow promptly, by large doses 
of iodide of potassium. 

After the first eighteen months iodide of potassium is generally 
indicated. This is commonly given together with the mercury, con- 
stituting the mixed treatment. The following formula, or one similar 
to it, may be employed : 



646 DISEASES. 

R.— Potassii iodidi ftii vel ^iv (8.0-16.0). 

Hydrarg. chlor. corros gr. ss (0.03). 

Syrup, aurant. cort 13J (32.0). 

Aquaa q.s. ad fgij (64.0).— M. 

S. — Teaspoonful (4.0) three times a day. 

When this prescription is put up a precipitate is formed and then 
dissolved. 

This mixture, or iodide of potassium without the mercury, admin- 
istered in 5- to 10-grain (0.3-0.65) doses three times a day, is given 
for from six to twelve months longer. When the iodide is given alone 
it is most conveniently administered in the form of a saturated solu- 
tion. Of this a drop contains a grain of the salt. Milk seems to 
have the power of completely disguising the disagreeable taste of the 
drug. Thereafter, specific treatment is stopped, unless symptoms 
arise, in which case it should be renewed and should be continued for 
many months. 

The protiodide is usually preferred, because the symptoms of its 
constitutional effect are manifest at first by looseness of the bowels, 
and because in practice it has been found one of the most satisfactory 
of all preparations. Where this form of mercury is not well borne 
the physician should at once employ some other salt ; the bichloride, 
in y^-grain (0.005) doses three times a day, is efficacious. Blue mass 
will often act favorably when other preparations cannot be tolerated. 
Its combination with iron is desirable, and the following formula rep- 
resents one of the most valuable of the antisyphilitic pills : 

R. — Mass. hydrargyri gr. xxx (2.0). 

Pulv. ferri chloridi gr. xv (1.0). — M. 

Ft. in pil. No. xii. 
S. — One three times a day. 

Where mercury cannot be administered by the mouth it may be 
given by means of vapor-baths, by inunctions, and by hypodermic 
injections. The vapor-baths are useful when it is desired to promptly 
cure eruptions on the surface of the body or when it is most import- 
ant to bring the clisease quickly under the influence of mercury. 
They are readily administered, the only apparatus required being an 
alcohol lamp and a plate in which the mercuric preparation can be 
volatilized. The patient is seated in a chair entirely naked; several 
blankets are wrapped around his neck, and beneath the tent thus 
formed a large vessel of steaming water is placed. When the skin 
is thoroughly softened J drachm (2.0) of calomel is sublimed by 
means of the lamp. These baths may be repeated every night until 
the mercuric foetor of the breath is observed or until the specific 
symptoms disappear. (See articles on Mercury and on Heat.) 

Inunction represents the most efficient way of administering the 
mercuric treatment. When the stomach is intolerant of drugs, or 
when, administered by the mouth in full doses, they do not favorably 
modify the symptoms, inunctions are indicated. The patient is 
instructed to take a warm bath, and the mercury is then well rubbed 
in over the inner surface of the forearm and arm and along the side 
of the chest for fifteen minutes. Either the oleate of mercurv, 10 



SYPHILrS. 647 

per cent., or the ordinary mercury ointment is commonly employed; 
the former is more cleanly, but less efficient. The rubbings should 
be done by the patient, should be made over a large surface of the 
body, and should be performed thoroughly; 1 drachm (4.0) of blue 
ointment is rubbed in daily. A shirt kept for this purpose is then 
put on next to the skin, and the ordinary clothing is worn over this. 
The next night the opposite arm and side of the body are utilized as 
the seat of inunction ; the following night the right groin and the 
inner surface of the right thigh and leg ; next, the same regions of 
the opposite side of the body ; finally, the anterior surface of the 
chest and abdomen. In this way irritation of the skin is avoided. 
Where it is impossible to employ the inunctions in this way, another 
means of causing absorption of mercury through the skin, suggested 
by Sturgis, will be found satisfactory : After a thorough soaking of 
the patient's feet in hot water, from \ to 1 drachm (2.0-4.0) of a 20 
per cent, oleate of mercury is rubbed vigorously into the sole of one 
foot; the next night the sole of the other foot is treated in the same 
way. The patient is directed to wear, night and day, a pair of wool- 
len socks : these are not changed for one week. Mercury may be 
taken by the mouth at the same time inunctions are employed when 
it is desired to influence the system quickly. In the late periods of 
the disease very striking effects are often obtained by supplementing 
the iodide treatment by a course of twelve to eighteen inunctions. 

The hypodermic administration of mercury is in this country lim- 
ited to those few cases which do not seem to respond to the drug 
when given by the mouth or by inunction. Although many prepara- 
tions of mercury have been lauded as most efficacious when used hypo- 
dermically, the best formula seems to be that recommended by Hebra. 
This consists of a solution of 1 per cent, of bichloride of mercury in 
a 6 per cent, sodium-chloride solution; the resulting mixture is per- 
fectly clear and is readily prepared. If it becomes turbid it should 
be thrown away. Most rigid antiseptic precautions must be observed, 
as abscess-formation is not uncommon. One injection is given daily, 
from \ to \ grain (0.01-0.02) of the sublimate being administered. 
The nates are selected as the seat of the injection, the solution being 
driven well into the muscles of each side every other day. Twenty 
injections are usually sufficient to cause the disappearance of all symp- 
toms. The employment of the insoluble preparations of mercury, 
particularly of calomel, gives much pain, frequently causes abscess, 
and is at times attended by a continuous absorption which may pro- 
duce severe and even fatal ptyalism. 

The ulcerations often found as tertiary manifestations of syphilis 
are treated according to general surgical principles. The local 
application of mercuric preparations is of less service than during 
the existence of the secondary lesions. Iodoform is peculiarly ser- 
viceable. 

The tonic and general treatment of syphilitic cases must not be 
forgotten ; fresh air, exercise, bathing, careful diet, regular living, all 
must be enjoined. Moreover, in certain cases where there is marked 
anaemia or physical weakness cod-liver oil, stimulants in moderation, 



648 DISEASES. 

compound syrup of the hypophosphites, and other tonic and nutritive 
courses of treatment must be carefully administered. 

Although the treatment of an ordinary case of syphilis is simple 
and satisfactory in its results, it must be remembered that there are 
malignant forms of the disease, attacking by preference feeble and 
cachectic individuals, running a rapid and virulent course, unchecked, 
nay aggravated, by specific treatment, and responding feebly, if at all, 
to the most careful hygienic and tonic regimen. In such cases a 
strong extract of sarsaparilla is sometimes of service. 



TETANUS. 

The treatment of tetanus is quite independent of its causation, 
so far at least as drugs are concerned, and is virtually identical with 
that of Strychnine Poisoning, to which the reader is referred. It is 
stated that Fowler's solution acts almost as a specific in some cases. 
(See Nux Vomica.) 



TONSILLITIS. 

Inflammation of the tonsils occurs in three forms : superficial 
tonsillitis, in which the mucous membrane covering the tonsils becomes 
inflamed through extension of a pharyngitis ; follicular tonsillitis, in 
which the follicles are chiefly involved and pour out an excessive 
secretion ; and, finally, true tonsillitis, in which the gland itself 
suffers from severe, widespread inflammation phlegmonous in type. 
In all these forms the treatment to be instituted at the beginning is 
practically identical. The bowels should be opened by a saline pur- 
gative, which in some cases should be preceded by small doses of 
calomel, the diet should be liquid and nutritious, and a fever and 
diuretic mixture should be given freely as follows : 

R. — Tine, aconiti Tt\,xij vel xxiv (1.0-1.6). 

Spt. setheris nitros f^j (32.0). 

Liq. potassii citratis . . . q. s. ad f^iij (96.0). — M. 
S. — Dessertspoonful every three hours. 

Locally, a solution of nitrate of silver, 60 grains to the ounce 
(4.0 : 32.0), should be applied with a camel's-hair brush or with a 
cotton applicator. Externally, an ice-bag should be applied about 
the throat, and as soon as the purgative has acted and the fever is 
reduced by the mixture just given, full doses of the tincture of the 
chloride of iron should be administered (20 drops [1.3] every three 
or four hours), in plenty of water, which preferably should be Vichy 
or one of the good lithia waters. 

In inflammatory involvement of the entire tonsil active scarifica- 
tion in the early stages may be of service in limiting the severity of 
the attack. In some instances hot fomentations about the neck and 
hot gargles seem to be more beneficial than the use of ice. Often a 



TUBERCULOSIS. 649 

mild antiseptic gargle of carbolic acid (1 : 100 of water) will relieve 
the pain and the foetor of the breath. 

Finally, it should be remembered that rheumatic persons suffer 
severely at times from tonsillitis, and the best remedies for this form 
of tonsillitis are the salicylates or guaiac. 

TUBERCULOSIS. 

Under this head will be considered pulmonary tuberculosis as a 
type of all forms of this morbid process. Its treatment may be 
placed in two lines — the first devoted to the cure of the disposition 
or inclination toward the disease or the abortion of its early stages ; 
the second directed to the improvement of the patient's condition, so 
that his progress through the disease may be made as comfortable as 
possible. Before doing this, however, it is proper to state that pro- 
phylaxis, or true prevention, is the object really to be sought after, 
although it is certainly true that many cases of early tuberculosis are 
curable. Recent studies have shown most conclusively that tubercu- 
losis is capable of being transmitted from man to man if air laden 
with the bacilli is breathed, and if the lungs are in a fit state of 
depressed vitality, from any cause, to afford a favorable field for the 
growth of the germ and the development of its poison. 

Cases of pulmonary consumption follow, rudely speaking, three 
well-defined lines. A very early stage sometimes comes to the care 
of the physician, and it is that in which the following history is given 
or a similar story is elicited. A patient, previously strong and well 
or of poor health, as the case may be, begins to lose vivacity. Life 
oecomes a burden and exercise is distasteful. A slight daily chill, in 
morning or evening, and fever develop, and the physician who is care- 
less treats the case as one of mild malarial poisoning. Careful exam- 
ination, however, will show an area in the lung, generally near the 
apex on one or both sides, where slight prolongation of expiration 
with a harsh inspiratory sound is heard, and where percussion will 
give impaired resonance or dulness. In other words, the first stage 
of phthisis is present, and the physician must resort at once to those 
active measures for the patient's relief which will be considered in a 
moment. 

In another form a chill, a sweat, a loss of flesh and vigor, with, 
more prominent than all, a hard cough, sudden in its onset and rap- 
idly becoming excessive with profuse expectoration, are the dominant 
symptoms. The wasting is extraordinary, the sweats are constant, 
and death may come in a few weeks. This is the form known as 
"galloping consumption." 

The third variety is ushered in by a gradual loss of vigor or a sen- 
sation of being a little unwell, or is brought before the patient's mind 
by a sudden acute hemorrhage, or several hemorrhages rapidly suc- 
ceeding one another. This variety passes along its course more or less 
rapidly. Sometimes death soon ensues from a fatal hemorrhage ; in 
other cases the disease keeps on for months and the case dies from 
exhaustion. 



650 DISEASES. 

Last of all, the fourth class is made up of persons who gradually 
pass from bad to worse: First, they "catch a cold," which hangs on 
longer than it ought, and, as soon as they are well, this is followed by 
another one, which is found more difficult to cure, until finally there 
is always a cough. Soon wasting comes on, strength is lost, and a 
long period of months or years ensues during which the progress 
of the case is now slow, now fast, the condition now better, now 
worse, until death ensues from wasting, pneumonia, or some other com- 
plication. 

These forms and stages have been roughly outlined, so that a dis- 
cussion of their treatment might be taken up with a clear idea of 
what is to be done. 

When a patient exhibits those physical signs which have been 
given as evidences of the early beginnings of phthisis, the physician 
should institute certain hygienic and medicinal measures. If the 
individual be earning a livelihood by following some confining occu- 
pation, this occupation must be given up and one undertaken which 
is carried on in the open air and yet not accompanied by too great 
exposure. Even if exposure is incurred, it is better than the occu- 
pation previously followed : thus, if the patient be a bookkeeper, a 
printer, or a bookbinder, or a clerk kept much at a desk in an ill- 
ventilated room, a few wettings in the rain will do little or no harm 
if properly treated by the wearing of flannel shirts, which, when wet, 
are changed as soon as labor ceases, as under these circumstances the 
danger of catching cold is at a minimum. (See Part III., article on 
Climate.) 

The medicinal measures to be carried out in all cases of phthisis, 
except that known as the galloping form, are not numerous if we 
confine ourselves to the modes possessing any real value. For many 
years cod-liver oil has been sadly abused in the management of these 
cases, and has been given at all stages, owing to ignorance of its 
proper use as a general rule. The writer believes that the following 
rules are never to be departed from : 

1. Never use cod-liver oil where the disease has passed the 'primary 
stages of thickening of the lung and roughening of the respiratory 
sounds, unless fibroid changes are going on and the changes are very 
slow indeed. 

2. The use of cod-liver oil when rapid degenerative changes are 
occurring in the lung is distinctly harmful, as it is not of any service, 
disorders the digestion, and destroys the appetite. 

When the oil is used it should be given as directed in the article 
on Cod-liver Oil. 

A remedy of some value as a curative and of great value as a 
palliative is creosote, first introduced by Bouchard some thirteen 
years ago, but only recently widely employed. Many cures have 
been claimed from its use in the early stages of phthisis, and it has 
been highly lauded by a number of European clinicians. In the 
author's experience it is merely a palliative to the cough and general 
discomfort, particularly when the disease is fully established, and the 
opinion expressed by Strumpell expresses so well the thought which 



TUBERCULOSIS. 651 

the author was about to write when he read Strumpell's article that 
his words are here given : " Taking it all in all, we find that creosote, 
even in large closes, has no injurious effect on tuberculosis. At times 
we notice an apparently favorable symptomatic effect. We failed, 
however, to observe any real influence exerted by creosote on the 
progress of the disease." 

On the other hand, the relief of some distressing symptoms pro- 
duced by creosote is never to be underrated. (See Creosote.) 

When creosote is used internally it may be given in the following 
formula : 

R.-— Creosoti ( beech wood) gtt. xxxij vel f^j (4.0). 

Ti\ gentian f^j (4.0). 

Alcoholis f?j (32.0). 

Vin. albse . ._ q. s. ad f^iv (128.0).— M. 

S. — Teaspoonfnl (4.0), in water or wine, three times a day. 

Better still, order in ascending doses (1 minim extra each dose) in 
milk or wine. 

Often a 1-drop (0.05) dose three times a day may be increased to 
5 drops (0.3) in the same period with advantage, and if given in 
ascending doses the author has frequently had patients take as much 
as 90 minims (6.0) a day. Sometimes 1 or 2 drops (0.1) in capsules 
are as useful as the formula just named. (For methods of administra- 
tion see Creosote.) 

Creosote may also be inhaled in the spray from a steam atomizer 
or by means of an inspirator fitted over the nose and mouth and 
made of perforated zinc with a sponge at the edge to hold the drug. 
A very good method is to wet the sponge with creosote, alcohol, 
and water, equal parts, or to use the creosote alone if coughing is not 
too severe. Another useful mixture consists of equal parts of tere- 
bene, iodide of ethyl, and chloroform. This last mixture is most 
useful when the secretion is tough and tenacious, and should not be 
used in the presence of acute irritation due to inflammation. Such 
inhalers are very cheap, not easily broken, and readily worn. 

If the cough in phthisis is excessive, a little spirit of chloroform 
placed on the sponge of the inhaler will often relieve it, or a mixture 
of morphine and wild-cherry bark may be given as follows : 

R. — Morphinae sulph. , ." gr. j vel ij (0.05-0.1). 

Syr. pruni Virginianse fjfiij (96.0). — M. 

S. — Teaspoonfnl (4.0) every three hours. 

Or the following : 

R— Potassii cyanidi gr. j vel ij (0.05-0.1). 

Morphinse sulph gr.j vel ij (0.05-0.1). 

Syr. pruni Virginianse fgiij (96.0). — M. 

S. — Teaspoonful (4.0) every four hours. 

In still other cases 2 to 10 minims (0.1-0.65) of a good fluid 
extract of cannabis indica, or J- to \ grain (0.008-0.016) of the solid 
extract, will act with surprising benefit and stop the cough. 

Very often during the course of phthisis localized spots of pleu- 
ritic inflammation arise. Without the occurrence of any exposure 



652 DISEASES. 

the patient will remark, " Doctor, I think I have taken a little more 
cold, and I have a stitch here in the chest." The best treatment is 
to apply a small blister or to paint the spot with iodine. 

(For the treatment of Haemoptysis see Hemorrhage.) 

Laryngeal phthisis, one of the most serious complications of this 
disease, is best prevented by ordering the patient to inhale the steam 
arising from boiling water which contains corrosive sublimate in the 
proportion of 1 : 10,000. If a proper watch is kept for evidences of 
a general mercurial effect, and this measure stopped at once when 
tenderness of the gums appears, no danger exists. Before the inhala- 
tion takes place a spray of cocaine (4 per cent, solution) should be 
thoroughly used. 

The treatment of laryngeal phthisis itself is various. The best 
method is that in which lactic acid is used. By the aid of a laryn- 
geal mirror and a cotton applicator a 10 per cent, solution of lactic 
acid is applied to the spots which are involved. As this is generally 
quite painful, cocaine solution should first be used. Gradually the 
strength of the lactic-acid solution should be increased to 60 per cent, 
if the weaker solutions do not check the disease. Very valuable 
results have been obtained by this method. 

The second method in point of value is that of iodoform insuffla- 
tions. A powder of iodoform alone is too light for satisfactory pro- 
pulsion into the larynx, and powdered talc should be added to it in 
small amount, as may also y 1 ^ grain (0.004) of morphine to each 
drachm (4.0) of iodoform. The odor is generally disagreeable to 
the patient, but if a cocaine spray be first employed and the operator 
is skilful, very little coughing is produced. As iodoform is a local 
anaesthetic, it relieves the pain in the larynx, acts as an antiseptic 
-and alterative, and is peculiarly obnoxious to the bacillus tuber- 
culosis. 

When the night-sweats are very violent, hypodermic injections of 
atropine in the dose of -^ to -^ grain (0.001-0.0012) are useful in 
■some cases, and the efficiency of this treatment may be increased by 
the use of an alum sponge-bath at bedtime. A solution of alum, 10 
to 20 grains to the ounce (0.65-1.3 : 32.0), may be sponged over the 
l>ody, or sulphuric acid may be added to water in the proportion of 1 
drachm to the pint (4.0 : 500 cc), and used in the same way as the 
alum solution. 

Sulphuric acid is often given internally with advantage in these 
cases of sweating. Small doses of pilocarpine amounting to -^V grain 
(0.003), given from one to two hours before the sweat is expected, are 
sometimes potent for good. The means by which this result is brought 
about are not far to seek. The drug in any dose causes great stim- 
ulation of the peripheral ends of the nerves supplying the sweat- 
glands. In many instances we find excessive secretion dependent 
upon depression of function, as in a serous diarrhoea or a local sweat- 
ing of the feet. These states pass away just as soon as the parts 
regain their normal tone through proper treatment. The night-sweats 
of phthisis are sometimes improved by pilocarpine, because this drug 
in all doses stimulates the sweat-glands. In large doses this stimula- 



TYPHOID FEVER. 653 

tion amounts to free diaphoresis; but in the minute doses, such as -^ 
to 2V of a grain (0.0016-0.003), the stimulation just balances the de- 
pression and a normal tone is acquired. While it is true that pilocar- 
pine and atropine are physiological antagonists, it will be found prac- 
tically beneficial to prescribe small doses of both in such cases as refuse 
to respond to either one alone, as by their antagonism they prevent 
over-action on other parts of the body, and both act in harmony 
in so influencing the sweat-glands as to be of service to the patient. 
Camphoric acid in 20- to 30-grain (1.3-2.0) doses is the best remedy 
and is invaluable in treating night-sweats. 



TYPHOID FEVER. 

Any attempt to review the treatment of the disease known as 
typhoid fever would be absolutely impossible, owing to the very 
numerous theories and practices put forward by various clinicians. 
What is said under the general heading of Fever and under the con- 
sideration of Cold, and also under Antipyrine and Acetanilid, gives 
sufficient information as to the treatment of febrile movements, and 
the care of the patient beyond this point in nearly all cases depends 
upon the severity of the attack. 

Before going further, however, the writer desires to insist very 
strongly upon one fact — namely, that a case of typhoid fever is not 
curable in any degree. No remedy yet found, except it act through 
the prevention of complications, can shorten its course. We can only 
guide the patient safely to health when the storm of disease comes on, 
and we cannot stop the storm. 

Not only should the facts of the last paragraph be carefully borne 
in mind, but the physician must remember that he is treating an 
exhausting disease — not a disease which runs a violent course for a 
few days and strands the patient sick and weak, but convalescent, 
upon the shores of health, but one in which, after sapping the 
strength for weeks, some sudden intercurrent malady or accident may 
ensue which will speedily kill him if every possible grain of strength 
is not preserved for the struggle. The physician should always put 
every case in which there is a suspicion of typhoid fever to bed at 
once, and keep the patient there till the disease has passed or fails to 
appear. Every muscular movement unnecessarily made is a waste of 
force, and, in consequence, everything should be done for the patient, 
and not by him. A bed-pan should always be employed, the patient 
not being allowed to sit erect upon a commode. Remembering, too, 
the force consumed in difficult digestion, the food should be liquid, 
free from fat, and consist solely, if not entirely, of milk, and during 
convalescence of an egg or a little arrowroot or corn-starch. Not only 
is this recommendation practically correct at the bedside, but it is well 
based on scientific fact, for Brieger has shown that typhoid bacilli do 
not readily reproduce themselves and their poisons in peptone and 
well-digested milk, but do so very actively in meat-broths or jelly 
which has not been acted upon by the digestive juices. He has also 



654 DISEASES. 

found that these bacilli generate two poisons, one of which causes, 
when given to animals, salivation, paralysis, and diarrhoea, the other 
violent and exhausting diarrhoea alone. Milk diet is therefore evi- 
dently better than broth diet in typhoid fever, and we once more are 
able to explain an empirical fact by a scientific discovery. Another 
reason for using liquid instead of solid foods, beyond the difficulty of 
digestion, is the fact that these solids may irritate or perforate the 
ulcers in the small intestines. 

Alcohol may be used in all stages as a stimulant, as a giver of 
force to the system, and as an aid to digestion. A very large part of 
the profession believe that the mere presence of an abnormally high 
temperature contraindicates the use of alcohol. Mere high tempera- 
ture does not do so, however, and it seems probable that many deaths 
have resulted from putting into practice such a belief. High tem- 
perature of a sthenic type, with a full, tense, bounding pulse and 
all the signs of a disease attacking one in the full vigor of life, 
of course precludes its use ; but in the high temperature of advanced 
typhoid, with the marked asthenia often present in that stage, alco- 
hol should be given constantly in large amount. Under these cir- 
cumstances the tissues which the man can afford to lose are gone, 
and much of the vital portion of his system is greatly encroached 
upon: the alcohol yields force to the body, and is burnt up in great 
part, keeping the flagging heart pumping the tides of blood through 
the lungs and systemic circulation, when otherwise the very cardiac 
depression would produce hypostatic congestion, if not more wide- 
spread circulatory failure. 

A no less useful and valuable result obtained by the use of alcohol 
in the early stages of exhaustive fevers is the part that it plays in aid- 
ing digestion. The writer has elsewhere defined the difference be- 
tween the influence of alcohol in the artificial digestion of the test- 
tube and that occurring in the stomach. No one doubts that alcohol 
added to a small amount of gastric juice in the test-tube retards or 
prevents its action; but evidence is abundant to prove that the inges- 
tion of this drug produces by its stimulating and irritant action a very 
decided increase in the quantity of gastric juice secreted over and 
above the amount normally present. Aside from experimental evi- 
dence, every-day experience has taught the gourmand that alcohol, 
in a fairly concentrated form, enables him to digest an amount of 
food which under ordinary circumstances would remain unchanged in 
his stomach. 

The importance of aiding the flagging powers of the stomach is 
not generally recognized ; but if one remembers the fact that at one 
time during the course of a severe attack of typhoid an occasion must 
come when a struggle between the few remaining grains of strength 
and the disease results in death or in recovery, its importance becomes 
evident. By the ingestion and digestion of more food early in the 
attack a larger amount of vital force remains for use at a crisis, and 
the chances of a recovery, to say the least, are increased. Alcohol 
may therefore be used all through the ordinary exhausting fevers — 
for the purpose in the first stage of aiding digestion, and in the later 



TYPHOID FEVER. 655 

stages of supporting the system ; but the physician ought not to use 
it as a routine measure in every case without a rational idea of why 
he does so. 

In those cases in which a temporary loss of heart-power is due 
to hemorrhage or to some sudden severe depression alcohol is one 
of the remedies to be employed — in a hot and concentrated 
form. 

That alcohol may be misused and cause great harm is of course 
known to every practitioner of medicine. So long as it reduces the 
temperature and lowers the rate of the pulse, causes a moist skin and 
tongue, and quiets nervous twitchings, it does good, and only up to 
this point is it to be employed. If its administration is pushed after 
this, the tendency to adynamia becomes, under the over-use of the 
drug, one of dynamia ; the pulse is no longer soft, but comes in angry, 
bounding beats ; the nervous symptoms change from low, weak, mut- 
tering delirium, with subsultus tendinum, to wild, incoherent callings 
and strong tossings to and fro ; and by and by, when the influence of 
the alcohol begins to decrease, and even before this time, the system has 
put forth the strength of days in a few hours, and the man, having no 
reserve strength, is dead. 

The treatment which has been used by the author in his wards at 
the Jefferson Medical College Hospital and St. Agnes's Hospital have 
given him results which the application of other methods have failed 
to give, and is as follows : 

As soon as the patient enters the house he is washed or bathed and 
placed in bed, and required to remain there. He is assured that the 
more quietly he lies the more mild and safe will be the course of his 
attack, and is made to use a bed-pan and urinal, and never allowed to 
get up. He is also given 5 drops (0.3) of dilute hydrochloric acid in 
a wineglass (32.0) of water every four hours, or, if the bowels are not 
active, nitromuriatic acid is substituted therefor, care being taken to 
employ 1, 2. or 3 drops of the strong, freshly-mixed orange-colored acid 
according to the degree of coating of the tongue. The diet is strictly a 
milk diet — namely, a quart to a quart and a half (1 to 1J litres) a day, 
with a little salt to flavor it, as already described in the article on 
Indigestion. In some cases koumyss acts very much better than milk. 
Sometimes, if vomiting is threatened, lime-water is added or the milk 
is peptonized, or beef-tea is temporarily employed. In other instances 
the milk agrees with the patient if it is partly diluted with plain soda 
or Apollinaris water. 

For the dry and sordes-covered tongue a mouth-wash of glycerin 
and water, half and half, to which may be added a little lemon-juice, 
is used. If constipation is very obstinate and continues over two 
days, an injection is employed, and if this, after being used twice, 
fails to act, a dose of calomel, \ grain (0.001) every fifteen minutes 
till a grain has been taken, is prescribed, and, if no movement occurs 
in twelve hours, is followed by J an ounce of sulphate of magnesium, 
or, best of all, a teaspoonful of liquorice powder is given. 

When diarrhoea becomes troublesome, over four or five passages a 
day, the following will be of service : 



656 DISEASES. 

R. — Acid, sulph. aromat f^ij (8.0). 

Extract, hsematoxyli fl f^iij (12.0). 

Syr. zingiberis fjiij (96.0). — M. 

S. — Teaspoonful (4.0) in water every hour until relieved. 

Just so soon as any evidences of tympanites or much meteorism 
come on turpentine is given, as follows : 

R .— 01. terebinthinse f^ij (8.0). 

Syr. acacise q. s. ad fjiij (96.0).— M. 

Ft. in emulsio. 
S. — Teaspoonful (4.0) three times a day. 

At the same time it is well to employ a turpentine stupe over the 
abdomen. (See Turpentine.) Where the tympanites is excessive it 
may be relieved by an injection made up as follows : 

R — 01. terebinthinse f^j to ij (4.0-8.0). 

01. olivse fjiv (128.0). 

Mist, asafoetidse Oj (500 cc.).— M. 

S. — Use as an injection. Shake well before using. 

In the later stages of typhoid fever, as convalescence is approached, 
turpentine is invaluable, as it causes rapid healing of the intestinal 
ulcers and stops diarrhoea, preventing relapses through the absorption 
of poisonous materials from the unhealed intestinal lesions. 

For many days after the patient begs hard for solid food it should 
not be allowed, for he will ask for it long before he should have it, 
but if the temperature remains normal for five days, very soft-boiled 
rice may be used in broth. Sometimes curds and whey make a pleas- 
ant change in the diet. 

The complications of typhoid fever of the most serious import are 
hemorrhage from the bowel, pneumonia and pleurisy, and perforation 
of the gut. 

The hemorrhage from the bowel may be stopped as indicated under 
that heading (Hemorrhage), and the pneumonia or pleurisy should 
be treated as are these diseases when free from complications ; but it 
is to be remembered that this is an asthenic or adynamic case, which 
must not be bled or depressed, but stimulated. When perforation of 
the intestine appears, large doses of morphine should be given to 
relieve pain, prevent collapse, and allay irritation. Warm applica- 
tions should be used over the belly and down the limbs, and stim- 
ulants given if needed. Probably in the future surgery will add 
another triumph to the art by devising some fairly safe plan of ope- 
rative interference in this accident, which, if left alone, is very 
often fatal. 

The method of cold bathing introduced by Brand has given such 
wonderful results in the treatment of typhoid fever, and has been so 
thoroughly tried, both in this country and abroad, that its application 
should be well understood and practised whenever it is possible to do 
so. The method consists in immersing the patient every three hours 
in a bath at a temperature of 85° F., or as low as 75° F. if neces- 
sary, and allowing him to remain in the water until the temperature 
falls to 100.5° or 101°, the bath being used with the frequency named 



JJRMMIA. 657 

as long as the temperature is above 102°. Before entering the bath 
it is well to give the patient J to 1 ounce (16.0-32.0) of whiskey in a 
little milk or water, to prevent any depression from his being moved 
into the tub. The patient will generally complain bitterly of the cold, 
particularly at first, and will also appear somewhat blue and chilly 
after the bath, but these signs are not to alarm the phj T sician unless 
there is prolonged and persistent coldness, when hot bottles should be 
applied to the feet and in some cases a little whiskey or brandy admin- 
istered. When the bath is given, cold should be applied to the vertex 
to prevent a congestion of the head, which, of course, is not under 
water. The patient should either be immersed or the directions given 
in Part III. in regard to the use of the cold pack be followed. The 
bath ought always to be near the bed, and a sufficient number of 
assistants should be present to lift the patient without his putting 
forth any exertion whatever, as this consumes his strength, which 
must be preserved with the greatest care. 

During the time the patient is in the bath the nurse should rub the 
surface of the body briskly in order to bring the blood to the surface 
and prevent congestions in internal organs. In cases where the 
patient objects so strongly to the cold bath that the physician cannot 
resort to it, it is sometimes possible to have the objections removed 
by putting the patient in the water at 95° F., and cooling the bath 
by the gradual addition of cold water to 75° F. 

It is said that pneumonia, intestinal hemorrhage, menstruation, 
nephritis, and cardiac complications are none of them contraindica- 
tions to this method of Brand, but the author would not resort to it 
if any of these conditions were actively present. 

One fact more should be stated — namely, that this method, while 
not wholly doing away with all other treatment, generally makes other 
measures unnecessary, although it is, of course, advisable to move the 
bowels every few days, if constipation be present, by injections, and 
to peptonize the milk if the digestion is faulty. 

The advantages gained by Brand's method are a mortality very 
much less than that of any other known method, the absence of high 
fever, the avoidance of disagreeable complications of all ki?2ds, and 
the production of a rapid convalescence. 



UREMIA. 

The treatment of this dangerous manifestation of renal disease is 
often futile, but always to be resorted to with the recollection that 
wonderful recoveries sometimes occur under judicious management. 
It matters little whether the onset of the symptoms has been gradual 
or instantaneous : in either event the prime endeavor must be to rid 
the system of the poison which is threatening life. This can only 
be accomplished by aiding its elimination through the bowels, skin, 
and kidneys. The second indication is to support the vital organs 
until the emunctories have had time to act. Often this second indi- 
cation will be more pressing than the first, and the physician will 

42 



658 DISEASES. 

have to give stimulants at once. The third indication is to arrest any 
convulsive seizures. 

The methods to be resorted to for the elimination of the urasrnic 
poison are external and internal, externally the hot pack being 
resorted to to increase the activity of the skin. (See Heat in Part III.) 
Internally we give elaterium or elaterin in the dose of -jt grain (0.01) 
or y 1 ^- grain (0.004), respectively, for the induction of watery purg- 
ing, which at once aids elimination through the bowel and relieves 
dropsy if present. The elaterin should be dissolved in a few drops 
of alcohol or in whiskey. The medication directed to increased action 
of the skin should consist of small doses, hypodermicallv — say -J- grain 
(0.01) — of hydrochlorate of pilocarpine, but this is contrainclicated 
unless the heart is believed to be strong and acting properly. If 
dropsy is present, the drug will have to be given by the mouth, as it 
will not be absorbed from the boggy subcutaneous tissues. Pilocarpine 
will also tend to increase the activity of the kidneys, and in addition 
to this influence on the renal structure w T e may use caffeine in the 
dose of 2 grains (0.1) every four hours for three doses, to stimulate 
the renal epithelium still remaining healthy to greater effort. 

For the support of the heart and respiratory function we employ 
strychnine hypoclermically or by the mouth in the dose of -^ to -^ 
grain (0.003-0.006), and follow it by the more powerful stimulant 
digitalis in the form of the tincture in the dose of 20 drops (1.3). 

The convulsions, if present or threatened, are to be combated by 
the use of an enema of 20 grains of chloral (1.3) and 60 grains (4.0) 
of bromide of sodium in 3 ounces (96.0) of starch-water, and the hot 
pack will also be of value, not only to produce sweating, but for its 
sedative influence on the venous system. Should the convulsive tend- 
encies be marked, chloroform inhalations may be employed until the 
chloral or bromide can be absorbed. According to Peabody and 
Kinnicutt, urethan is extraordinarily efficacious in uraemic convulsions, 
and they advise that the dose be very large, as much as 6 to 7 drachms 
(24.0-28.0) in twenty-four hours. It is said to lack the irritating 
properties of chloral, and to be lacking in dangerous effects on the 
heart. The drug may be given hypoderniically or by the rectum, dis- 
solved in water. 

Two other remedial measures should be resorted to in cases of 
uraemia for the relief of all the symptoms — namely, full venesection 
and hypodermoclysis. (See Part III.) Venesection is only contrain- 
dicated in the feeble. As much as 1 to 2 pints (J to 1 litre) may be 
withdrawn from a vein in the arm. After the bloodletting or during 
its progress hypodermoclysis may be performed or a saline solution 
transfused into the vein. (See Transfusion.) Often deep insensibility 
is speedily removed by venesection, which should be regarded as the 
sheet-anchor of treatment in those cases with a high blood-pressure. 

VITREOUS DISEASES. 

Vitreous opacities may be either dust-like, flaky, or dense and 
membranous. They impair vision in proportion to their number and 



VOMITING. 659 

density, and are to be detected with the ophthalmoscope. Patients 
detect them as floating dark spots in their field of vision, because the 
opacities cast a shadow upon the retina. If vitreous disease is 
syphilitic, the usual remedies are indicated. Hypodermic injections 
of pilocarpine act favorably, and in the earlier stages of the inflam- 
mations of the retina, choroid, iris, and ciliary body, upon which the 
opacities depend, leeches should be applied to the temple. Gal- 
vanism has been recommended. 



VOMITING. 

Vomiting is of course a symptom, not a disease, and arises from a 
large number of causes, some of which are very unimportant, others 
very serious. The most common cause is probably lack of proper 
digestion, with all that this implies; that is, gastro-intestinal irrita- 
tion and perversion of normal function. Additional causes are cer- 
ebral hemorrhage, tubercular meningitis, cerebritis, uraemia, or dis- 
eases of the middle lobe of the cerebellum, all of which conditions 
cause irritation of the vomiting centre. 

All these states may be considered as lesions of a centric charac- 
ter which directly or indirectly cause the vomiting centre to send out 
impulses. On the other hand, it is worthy of note that under certain 
circumstances vomiting may be reflex and dependent upon irritation 
of the nerves of the stomach or elsewhere which convey impulses to 
the muscles whose activity results in vomiting. These conditions are 
well represented by the vomiting which comes on in incarcerated 
hernia, or in pregnancy, or in that occurring during the passage of 
renal or hepatic calculi, or in indigestion. 

It is important to bear in mind that peripheral vomiting due 
to disorder of the gastric walls may be dependent upon two con- 
ditions. The mucous membrane and its nerves may be over- 
excitable or they may be depressed. For this reason we shall find 
that two modes of treatment are necessary when this subject is 
considered below. 

The mechanism of vomiting consists in the closure of the pyloric 
sphincter, the contraction of the gastric muscles from the pylorus to 
the carclia, and at the same time, and more important than these 
movements, the contraction of the supplementary respiratory and 
abdominal muscles, which so compress the stomach as to drive out its 
contents through the open oesophagus. The violence of the muscular 
contractions in the abdominal walls is greatest when the stomach is 
partly empty, and gives rise to the pain and exhaustion accompanying 
the condition known as retching. The practical point to be learned 
from this is that vomiting is always easier when the stomach is full ; 
so if an emetic is given on an empty stomach, as the popular expres- 
sion runs, a large amount of liquid should precede or accompany it if 
possible. Dogs vomit easily because of the development of the gas- 
tric muscles, but they render the effort easier by filling the stomach 
with air, and so completely fill the viscus that its walls can contract 



660 DISEASES. 

Having described the mode and causes of vomiting, it still remains 
for us to consider its treatment. 

It is needless to remark that the vomiting of cerebral disease is 
very intractable, and that very active agents must be used to stop it. 
Probably the vomiting following etherization is centric, and should 
be treated, as should all forms of obstinate emesis, by the injection 
into the rectum of 40 grains (2.65) of sodium or potassium bromide 
and 20 drops of laudanum in 4 to 8 ounces (128.0-256.0) of water. 
If this does not stop the vomiting, a second injection may be given 
one hour after the first. A very valuable remedy in this state is 
acetanilid given in 1 grain (0.05) closes every half hour in a drachm 
of brandy with cracked ice (acetanilid). 

When vomiting seems to be due to hyperexcitability of the gastric 
mucous membrane, so that very small amounts of food when swallowed 
are at once rejected, local anaesthetics and depressants are needed, the 
chief of these being cocaine and aconite. Both of these drugs, how- 
ever, have disadvantages, because in effective dose their general phys- 
iological action may be very severe and almost poison the patient. 
When given to act as antiemetics, these drugs do so by acting as local 
anaesthetics, or, in other words, by paralyzing the peripheral sensory 
nerves. Cocaine should be given in the dose of 2 to 3 drops (0.1- 
0.15) of a 4 per cent, watery solution every fifteen minutes until 10 
drops (0.65) are taken. The aconite should be used in the form of 
the tincture, the patient being placed flat on the back, so as to with- 
stand the ensuing cardiac depression with the least inconvenience, 
and 2 to 5 drops (0.1-0.3) of the drug given in a little water every 
thirty minutes until the rapidly weakening pulse forbids its further 
use. This drug may be resorted to in all forms of vomiting due to 
irritability of the stomach, but it is contraindicated in cases of debil- 
ity or weakness. Aconite is generally to be preferred to cocaine. 

Sometimes a prescription of the following character is of service, 
the bismuth acting as a coating to the walls of the stomach, protect- 
ing and. soothing them: 

R. — Bismuthi subnitrat giij (12.0). 

Tr. aconiti gr. xx vel xxx (1.3--2.0). — M. 

Ft. chart. No. x. 
S. — One powder every half-hour. 

In other cases of the same type the following is useful, and is to 
be preferred if, owing to active fermentation, the vomiting is ex- 
cessive (the creosote or carbolic acid being a local anaesthetic and 
antiseptic) : 

R. — Acid, carbolic, vel creosoti (beechwood) . gtt. x vel xx (0.65-1.3). 

Bismuthi subnitratis giij (12.0). — M. 

Ft. in chart. No. x. 
S. — One powder every hour. 

In other cases 1 drop of tincture of iodine and 1 drop of carbolic 
acid in a couple of drachms of water will act very well. 

Sometimes pure chloroform in 1- or 2-drop (0.05-0.1) doses, in a 
little water, does good ; and dilute hydrocyanic acid, in the dose of 2 



VOMITING. 661 

to 6 drops (0.1-0.4) is also of value in like instances, given in a 
tablespoonful (16.0) of water. 

In other instances small repeated doses of nitroglycerin do good 
unless the vomiting complicates peritonitis or pregnancy. Particu- 
larly is nitroglycerin useful in the nausea which often follows the 
use of opium, although this symptom is best prevented by its use. 
The dose used should be about -%fa grain (0.0002). 

The treatment of a case of vomiting dependent rather upon de- 
pression and debility of the stomach than upon irritation is directed 
to the administration of gastric and, it may be, systemic stimulants. 
The chief of the gastric stimulants is ipecac in small doses, and it 
it is this employment of a drug generally resorted to for the produc- 
tion of emesis by physicians which has caused homoeopaths to claim 
that the regular school obey the law of similia similibus curantur and 
infinitesimal doses. The claim only holds good on its face, for we do 
not use an infinitesimal dose, and obey no law, but use common sense. 
Ipecac is an irritant, even to the skin, and it is partly by its irritant 
effects that it causes vomiting by exciting the stomach to a point over 
and above its normal condition. In the vomiting depending upon 
gastric debility and depression small doses of ipecac do good, because 
they irritate the stomach sufficiently to restore its normal tone with- 
out going to the other extreme of hyperexcitation. Under these cir- 
cumstances a drop dose of the wine of ipecac, or J of a grain (0.016) 
of the powdered ipecac, every hour, is of the greatest value, often 
succeeding after all other remedies have failed. 

In other instances tincture of nux vomica, given in J- to 1-drop 

(0.025-0.05) doses, is useful as follows : 

R —Tin ct. nucis vomica? gtt. iv vel viij (0.25-0.5). 

Aquae cinnamomi fjfj (32.0). — M. 

S. — Teaspoonful (4.0) every half-hour or hour. 

In the nausea and vomiting following an alcoholic debauch J to 1 
drop (0.025-0.05) of Fowler's solution every two hours, or before 
food, often gives relief, and it may be used in some cases in place of 
the nux vomica and ipecac. Another useful measure for the cure of 
alcoholic nausea is the use of full doses of hydrochloric acid, 5, 10, 
or 15 drops (0.3-0.65-1.0) of the dilute acid in half a tumblerful of 
water, repeated every two hours. 

In all cases of persistent vomiting counter-irritation should be 
applied over the stomach in the form of a mustard plaster, or, if 
preferred, an ice-bag may be applied to the nape of the neck, the 
lumbar spine, or the epigastrium. 

The food given in cases of vomiting should be especially prepared. 
It is always best to use peptonized milk, made by using the pepton- 
izing materials sold by all the large drug firms of reliability. (See 
article on Diet, Part III.) Lime-water should always be put in the 
milk if it is not peptonized ; the amount usually employed is per- 
fectly useless, because of its smallness : at least 2 to 3 tablespoonfuls 
(32.6-48.0) should be placed in each glass of milk. 

Another point of importance is the quantity of liquid taken. As 
fast as the patient vomits he is often fed with glasses full of liquid 



662 DISEASES. 

by well-meaning friends. Instead of this, he should have only 1 or 
2 teaspoonfuls (4.0-8.0) of milk every hour, half-hour, or fifteen min- 
utes, for it is better for him to retain a drachm than to take a quart 
and vomit it. 

Where vomiting is absolutely persistent enemata previously partly 
or entirely digested must be resorted to. 



WHOOPING COUGH. 

The remedies recommended for this disease are almost as numer- 
ous as the members of the medical profession, and every one of them 
is worthless so far as a cure is concerned. Probably the very best 
drug of all in the majority of cases is antipyrine. Given in the dose 
of J to 3 grains (0.025-0.15) every five hours according to the age 
of the child, it will nearly always decrease the number of paroxysms, 
but not the severity of each individual attack. 

Where the child will submit to it there is little doubt that quinine 
in a very fine spray will be of service in many cases, and it is very 
useful, when so used, as a prophylactic in other children of the family 
who it is feared will be attacked by the same disease. The strength 
of the solution to be employed should be about 1 grain (0.05) to the 
ounce of water. 

There is no doubt that carburetted hydrogen as inhaled at gas- 
works is useful as a curative measure in cases of whooping cough. 

A very useful remedy in some cases is belladonna in the form of 
the tincture, in the dose of h drop (0.025) twice a day to a child of 
one or two years. Where great vascular engorgement ensues upon a 
severe coughing spell vascular sedatives are of service ; that is, in 
those cases in which hemorrhages from the nose, ears, and mouth 
take place veratrum viride or aconite may be used, unless the disease 
has already so exhausted the child that stimulants are needed, and 
cardiac sedatives are contraindicated by the degree of adynamia 
present. The reason for this lies in the following facts : The vascu- 
lar tension consequent upon the obstruction of respiration causes a 
rise of blood-pressure from asphyxia, and the hemorrhages or the 
conjunctival ecchymoses are due to rupture of the small blood-vessels 
under the increased strain. By lowering vascular tension we prevent 
so great a spasm of the blood-vessels and avoid vascular rupture or 
distention. 

Where paroxysms come on so rapidly as really to interfere seri- 
ously with respiration, the child should take a whiff of chloroform 
poured over the parent's hand, and so relax the spasm, while in other 
instances nitrite of amyl is equally serviceable. Only 2 to 3 drops 
of the nitrite of amyl should be used at a time, and this fact must 
be impressed upon the parents. 

Benzine has been found useful in certain -cases of whooping cough. 
It should be lightly sprinkled about the room or on the bed-clothing. 
In France it has been used internally in the dose of 10 to 15 drops 
(0.6-1.0) for this affection. This is scarcely to be recommended. 



WORMS. 063 

Bromoforro renders good service in some cases. (See article for 
prescription.) 

The vomiting following the cough may be overcome by using such 
minute amounts of milk as to enable nutrition to go on without at 
any time overloading the stomach, as, for example, a teaspoonful (4.0) 
after each paroxysm of cough. 

Often it will be found possible to modify the severity and frequency 
of the attacks by keeping the patient under a bronchitis tent or by 
keeping the air of the room moistened by steam. (See Bronchitis.) 



WORMS. 

Intestinal parasites may be said to be represented by the Ascaris 
lumbricoides, or round-worm ; the Taenia ■ solium, Taenia media 
canellata, and the Bothriocephalus latus, or tape-worms ; and, finally, 
by the Oxyuris vermicularis, sometimes called seat-, pin-, or thread- 
worm. 

The round-worm and tape-worm are to be attacked by way of the 
patient's mouth, the seat-worm by way of the anal opening ; but 
before mentioning the drugs to be employed it is necessary to insist 
upon one or two important points, disregard of which will result in 
failure in treatment. 

Whenever a round- or tape-worm is to be attacked, the patient 
must be starved for at least twelve to twenty-four hours, in order that 
no food in the intestinal tract may protect the worm from the action 
of the drug. During this time a little milk may be taken, and after 
a night of fasting, before breakfast, the anthelmintic must be swal- 
lowed. Further than this, nearly all of these drugs must be followed 
by purges in order to dislodge the intruder while he is paralyzed and 
has lost his hold ; and in many instances it is well to have a basin of 
salt and water ready, so that when a passage occurs a rectal injection 
may be given to wash out any segments of the worm which remain 
behind in the rectum. 

In the treatment of thread-worms it is necessary to fill the bowel 
thoroughly with soap and water to dislodge the fecal matter and 
expose the worms in the folds of the mucous membrane. 

The drugs which are used against the round-worm are: Spigelia in 
the form of the fluid extract, dose 1 drachm (4.0) to a child of two 
or three years, or 2 drachms (8.0) to an adult, or, better still, the fluid 
extract of spigelia and senna, dose 2 to 3 drachms (8.0-12.0), given 
in divided doses, to a child ; oil of chenopodium, dose 5 to 20 drops 
(0.3-1.3) on sugar; santonin, dose \ to \ grain (0.016-0.025) to a 
child, in the form of troche, made by using the crystals, or as much 
as 2 to 4 grains (0.1-0.2) to an adult. (See Santonin.) 

Brayera, or kooso, is given for the removal of the same worm in 
the form of an infusion, which is made by adding \ ounce (16.0) of 
the powdered leaves to 1 pint (500 cc.) of water and mucilage of 
acacia, one-half of each. This may be taken at one dose, or the 
fluid extract may be given in the dose of \ ounce (16.0) to an adult, 



664 DISEASES. 

Koosin may be given in 40-grain (2.65) doses in capsule to adults, 
but it should not be used against worms in pregnant women, as it 
may cause abortion. 

Unless the spigelia is used with senna, it should always be followed 
after from two to four hours by a full dose of castor oil or a saline 
purgative to sweep out the worm, and the same rule applies to all the 
drugs mentioned above. 

The most efficient remedy against the tape-worm is pelletierine, 
the active principle of pomegranate, dose 1 to 2 grains (0.05-0.1) in 
capsules; or pepo, or pumpkin-seeds (2 ounces [64.0]), may be 
resorted to when deprived of their outer coating and rubbed into a 
paste with sugar. Almost, if not quite, as valuable a remedy is male 
fern, or Filix mas, or, as it is officially called, Aspidium. Used in 
the form of the oleoresin (Oleoresina Aspidii), in the dose of J to 1 
drachm (2.0-4.0) to an adult, it should be followed in three or four 
hours by a calomel purge, aided by a saline. Either the calomel or 
the increased amount of bile which is present is apparently peculiarly 
abhorrent to the tape-worm, and its free excretion should follow the 
use of all the drugs just named. Aspidium should not be followed 
by castor or other oils, as they increase the absorbability of the drug, 
and so tend to develop poisonous symptoms. 

By far the most useful remedy for seat-worms is quassia used by 
injection. 1 to 2 ounces (32.0-64.0) of powdered quassia or quassia 
chips may be made into a decoction with a pint (500 cc.) of water, 
and half of this injected into the rectum after it has been well 
cleansed with soap and water. The quassia injection should be 
retained in the bowel for some minutes, and in children this may be 
accomplished by pressing upon the anal opening the ball of the 
thumb covered by a pad formed from a small folded towel. If this 
treatment fails to bring away all the worms in three or four trials, 
either there are none present or the bowel is not thoroughly invaded 
by the injection. In some cases the worms infest the colon, and large 
injections sent high up into the bowel are necessary. 



DOSES OF MEDICINES. 



dr. = drachm ; fl. dr. = fluidrachm ; fl. oz. = fluidounce ; gr. 
min. = minim : oz. = ounce. 



gram ; gm. — gramme 



Remedy. 



Acetanilid 

Acetophenone 

Acetphenetidin 

Acetum lobelise 

opii 

sanguinarise 

scillse 

Acid, acetic, diluted . . . 

arsenous 

solution of (Ph. U. S. 

benzoic 

boric 

carbolic 

chrysophanic . . . . . 

citric ... 

fluoric, dilute 

gallic 

hydriodic, dilute . . . 

hydrobromic, dilute . . 

hydrochloric 

dilute 

hydrocyanic, dilute . . 

lactic 

nitric 

dilute 

nitrohydrochloric . . 

phosphoric, dilute . . . 

picric 

polygalic 

salicylic 

sulphuric 

aromatic 

dilute 

sulphurous 

tannic 

tartaric ....... 

valerianic 

Aconite, abstract of . . . 

leaves, extract of . . . 
fluid extract of . . . 
tincture of 

root, extract of ... . 
fluid extract of . . . 

tincture of 

Aconitine 

Adonidin 

JEther. See Ether. 



Dose. 



Apothecaries' 
Weights and Measures. 



1-8 gr. 

5-20 min. 

2-5 gr. 
15-30 min. 

5-10 min. 
15-30 min. 
10-30 min. 

1-2 fl. dr. 

2-8 min. 
5-15 gr. 
5-10 gr. 

i-1 gr. 

\-h min. 

5-20 gr. 
10-20 min. 

3-15 gr. 

i fl. dr. 

i-2fl.dr. 

2-5 min. 
10-20 min. 

2-5 min. 

1-3 dr. 

2-5 min. 
10-25 min. 

2-5 min. 

5-25 min. 

1-5 gr. 

1-1 gr- 

5-15 gr. 

2-5 min. 

5-20 min. 

5-20 min. 

1-1 fl. dr. 

2-10 gr. 
10-30 gr. 

3-4 min. 

Hgr- 

H gr. 

1-5 min. 
10-15 min. 

e^¥ gr- 
|-1 min. 
1-3 min. 

1 _ 1 crv 

ro o 300 gr- 
iW gr- 



Metric 

System. 



0.06-0.5 gm. 

0.3-1.25 gm. 
0.12-0.3 gm. 

1.0-2.0 gm. 

0.3-0.6 gm. 

1.0-2.0 gm. 

0.6-1.8 gm. 

4.0-8.0 gm. 

0.001-0.003 gm. 

0.12-0.5 gm. 

0.3-1.0 gm. 

0.3-0.6 gm. 
0.03-0.06 gm. 
0.008-0.3 gm. 

0.3-1.25 gm. 

0.6-1.2 gm. 

0.2-1.0 gm. 
2.0 gm. 

2.0-8.0 gm. 
0.12-0.3 gm. 

0.6-1.2 gm. 
0.12-0.3 gm. 

4.0-12.0 gm. 
0.12-0.3 gm. 

0.6-1.5 gm. 
0.12-0.3 gm. 

0.3-1.5 gm. 

0.06-0.3 gm. 

0.015-0.06 gm. 

0.3-1 gm. 
0.12-0.3 gm. 

0.3-1.2 gm. 

0.3-1.2 gm. 

2-4 gm. 

0.12-0.6 gm. 

0.6-2 gm. 

0.2-0.25 gm. 
0.015-0.03 gm. 
0.015-0.03 gm. 
0.06-0.3 gm. 

0.6-1.0 gm. 

0.01-0.016 gm. 

0.03-0.06 gm. 

0.06-0.18 em. 

0.00015-0.0002 gm. 

0.005-0.01 gm. 

665 



666 



DOSES OF MEDICINES. 



Remedy. 



Agaricin 

Aloes 

extract of 

and myrrh, tincture of 

tincture of 

watery extract 

wine of 

Aloin 

Alumen 

(as emetic) 

Aluminium hydrate 

Ammonia, aromatic spirit 

solution of acetate of 

spirit of 

water of 

Ammoniacum 

mixture 

Ammonium benzoate 

bromide 

carbonate 

chloride 

iodide 

phosphate 

picrate 

sulphate 

valerianate 

Amygdala amara, water of 

Amyl nitsite 

by inhalation 

Amylene hydrate 

Amylum iodatum 

Angelica- root, fluid extract 

Angustura-bark 

Anise, oil of 

spirit of . 

Anthemis 

extract 

fluid extract 

Antimonial powder 

Antimony oxide 

oxysulphuret 

and potassium tartrate, as diaphoretic 
as emetic '■ - 

sulphide 

sulphurated 

sulphuret 

wine of 

Antipyrine 

Antitoxine (for diphtheria) 

Apiol 

Apocynin 

Apocynum cannabinum 

fluid extract of 

Apomorphine hydrochlorate 

Aralia hispida, fluid extract of ... . 

nudicaulis, fluid extract of 

racemosa, fluid extract of 

spinosa, fluid extract of 

Arbutin 

Areca, fluid extract of 

Argentum and compounds. See Silver. 
Arnica-flowers, extract of 



Dose. 



Apothecaries' 
Weights and Measures. 



T2-J gr- 

2-6 gr. 

2-6 gr. 

] -2 fl. dr. 

1-2 fl. dr. 

1-2 gr. 

1-2 fl. dr. 

1-3 gr. 

5-10 gr. 
30 gr.-l dr. 

5-15 gr. 
30 min.-l fl. dr. 

1-2 fl. dr. 

5-15 min. 

2-6 gr. 
10-30 gr. 

\-\ oz. 
10-20 gr. 
10-30 gr. 

3-10 gr. 

5-10 gr. 

3-5 gr. 
10-20 gr. 

\rh g r - 

3-10 gr. 

2-8 gr. 

1-2 fl. dr. 

2-3 min. 

3-5 min. 
10-30 min. 

5-30 gr. 
30-60 min. 
10-30 gr. 

1-5 min. 

1-2 fl. dr. 

i-1 dr. 

2-10 gr. 
30-60 min. 

1-3 gr. 

2-3 gr. 

f-2 gr. 



gr. 



1-1 gr 



1-2 gr. 
1-2 gr. 
10 min.-l fl. dr. 
5-15 gr. 
5-10 cc. 
2-5 gr. 
i-2gr. 
10-20 gr. 
10-30 min. 

T5-To gr- 
30-60 min. 
30-60 min. 
30-60 min. 
30-60 min. 

1-10 gr. 
30-60 min. 

2-5 gr. 



Metric 
Svstem. 



0.005 

0.1 

0.1 

4.0 

4.0 

0.03 

4.0 

0.06- 

0.3 

2.0 

0.3 

2 

4 

0.6 

0.1 

0.6 

16 

0.6 

0.6 

0.18 

0.3 

0.18 

0.6 

0.016 

0.18 

0.12 

4.0 

0.12 

0.18 

0.6 

0.3 

2.0 

0.6 

0.06 

4.0 

2 

0.12 

2.0 

0.06 

0.12 

0.03 

0.004 

0.03 

0.03 

0.06 

0.03 

0.6 

0.3 



-0.015 gm. 
0.35 gm. 
0.35 gm. 
-8.0 gm. 
-8.0 gm. 
-0.12 gm. 
-8.0 sm. 
-0.18 gm. 
0.6 gm. 
-4.0 gm. 
-1.0 gm. 
-4 gm. 
-8 gm. 
-1.0 gm. 
0.35 gm. 
-2 gm. 
-32 gm. 
-1.2 gm. 
-2 gm. 
0.6 gm. 
-0.6 gm. 
-0.3 gm. 
-1.2 gm. 
0.03 gm. 
-0.6 gm. 
-0.48 gm. 
-8.0 gm. 
-0.18 gm.. 
-0.3 gm. 
-2.0 gm. 
-2.0 gm. 
-4.0 gm. 
-2.0 gm. 
-0.3 gm. 
-8.0 gm. 
-4 gm. 
-0.6 gm. 
-4.0 gm. 
-0.18 gm. 
-0.18 gm. 
-0.12 gm. 
-0.03 gm. 
-0.06 gm. 
-0.12 gm. 
-0.12 gm. 
-0.12 gm. 
-4 gm. 
-1.0 gm. 



0.12-0.3 gm. 
0.03-0.12 gm. 

0.6-1.2 gm. 

0.6-2.0 gm. 
0.004-0.006 gm. 

2.0-4.0 gm. 

2.0-4.0 gm. 

2.0-4.0 gm. 

2.0-4.0 gm. 
0.06-0.6 gm. 

2.0-4.0 gm. 

0.12-0.3 gm. 



DOSES OF MEDICINES. 



667 



Remedy. 



Arnica-flowers, fluid extract of 

root, extract of 

fluid extract of 

tincture of 

Aromatic powder 

Arsenate of sodium, solution of 

Arsenic. See Acid, arsenous. 

bromide 

iodide 

and mercury iodide, solution of (Dono- 
van's solution) 

Arsenite of potassium, solution of (Fowler's 

solution) 

Asafcetida 

mixture of 

tincture 

Asclepias incarnata, fluid extract of . . . 

Syriaca, fluid extract of 

tuberosa 

Aspidium, fluid extract of 

oleo-resin of 

Aspidosperma, abstract of 

fluid extract of 

Atropine sulphate 

Aurantii cortex, fluid extract of 

Azedarach, fluid extract of 

Balsam of Gurjun 

of Tolu 

Baptisia, extract of ... 

fluid extract of 

Baptisine 

Belladonna, abstract of 

alcoholic extract of 

leaves, fluid extract of 

tincture of 

root, extract of 

fluid extract of 

Benzanilide 

Benzoin, compound tincture of 

tincture of 

Benzol 

Berberina 

sulphate 

Berberis aquifolium, fluid extract of . ' . . 

vulgaris, fluid extract of 

Bismuth and ammonium, citrate of ... . 

citrate 

salicylate 

subcarbonate 

subnitrate 

tannate 

valerianate 

Boldo, fluid extract of 

oil of 

tincture of 

Brayera 

fluid extract of 

infusion of 

Bromal 

Bromoform 

Brucina 



Dose. 



Apothecaries' 
Weights and Measures. 



5-15 gr. 

2-5 gr. 

5-15 gr. 
10-20 gr. 
10-30 gr. 

3-5 min. 



-4 min. 



5-10 min. 

2-5 min. 

5-20 gr. 

|-1 fl. oz. 

30 mim-1 fl. dr. 

15-30 min. 

15-30 min. 

15-30 min. 

1-2 fl. dr. 
30 min.-l fl. dr. 

5-20 gr. 
15-30 min. 

1 _ 1 o-r 

"120 40 5 r - 

15 min.-2 fl. dr. 
15-60 min. 
20-30 min. 
10-30 min. 

2-10 gr. 
10-30 min. 

2-5 gr. 

*-l* gr- 

irk gr. 

3-6 min. 
10-20 min. 

1-2 min. 

1-5 gr. 
30 min.-l fl. dr. 

i-1 fl. dr. 

5-10 min. 

3-10 gr. 

3-10 gr. 
15-30 min. 
15-30 min. 

1-10 gr. 

3-15 gr. 

5-15 gr. 

5-20 gr. 

5-20 gr. 

5-30 gr. 

1-3 gr. 

5-15 min. 
5 min. 
8 min. 

2-3 dr. 

i-1 fl. oz. 

4-8 oz. 

2-3 gr. 

5-10 min. 
TfWe g r - 



Metric 
System. 



0.3-1.0 gm. 

0.12-0.3 sin. 

0.3-1.0 gm. 



mi 



0.6-1.2 
0.6-2.0 gm. 
0.18-0.3 gm. 

0.06-0.024 gm. 
0.004-0.008 gm. 

0.3-0.6 gm. 

0.12-0.3 gm. 

0.3-1.2 gm. 

15-30 gm. 

2-4 gm. 

1.0-2.0 gm. 

1.0-2.0 gm. 

1.0-2.0 gm. 

4.0-8.0 gm. 

2.0-4.0 gm. 

0.3-1.2 gm. 

1.0-2.0 gm. 
0.0005-0.0015 gm. 

1.0-8.0 gm." 

1.0-4.0 gm. 

1.2-2.0 gm. 

0.6-2.0 gm. 
0.12-0.6 gm. 

0.6-2.0 gm. 

0.12-0.3 gm. 

0.03-0.1 gm. 

0.016-0.03 gm. 

0.18-0.36 gm. 

0.6-1.2 gm. 

0.008-0.016 gm. 

0.06-0.12 gm. 

0.06-0.3 gm. 

2.0-4.0 gm. 

2.0-4.0 gm. 

0.3-0.6 gm. 
0.18-0.6 gm. 
0.18-0.6 gm. 

1.0-2.0 gm. 

1.0-2.0 gm. 
0.06-0.6 gm. 
0.18-1.0 gm. 

0.3-1.0 gm. 

0.3-1.2 gm. 

0.3-1.2 gm. 

0.3-2.0 gm. 
0.06-0.18 gm. 

0.3-1.0 gm. 
0.3 gm. 
0.5 gm. 

8.0-12.0 gm. 
15.0-30.0 gm. 
118.0-236.0 gm. 
0.12-0.2 gm. 

0.3-0.6 gm. 
0.002-0.004 gm. 



668 



DOSES OF MEDICINES. 



Remedy. 



Bryonia, fluid extract of 

tincture of 

Buchu, fluid extract of 

Buckthorn, fluid extract of 

Cactus grandiflora, fluid extract of . . 
Caffeine 

citrate of 

Cajeput, oil of 

Calamus, fluid extract of 

Calcium benzoate 

bromide . . 

carbonate 

chloride 

hypophosphite 

iodide 

lactophosphate, syrup of 

phosphate 

sulphide 

Calendula, fluid extract of 

tincture of 

Calomel. See Mercury, mild chloride of. 
Calumba, extract of 

fluid extract of 

tincture of. . . 

Calx chlorata 

sulphurata 

Camphor 

bromide 

monobromated 

spirit of 

water 

Camphoric acid 

Cannabin tannate 

Cannabis Americana, fluid extract of . 

Indica, abstract of 

extract of 

fluid extract of 

tincture of 

Cantharides 

tincture of 

Capsicum ' 

fluid extract of 

oleoresin of 

tincture of 

Caraway, oil of 

Carbon bisulphide 

Cardamom, compound tincture of . . 

fluid extract of 

tincture of 

Caryophyllus, oil of 

Cascara sagrada 

extract of 

fluid extract of 

Cascarilla 

fluid extract of . 

Cassia fistula, pulp of 

Castanea vesca, fluid extract of . . . . 
Castor . . 

tincture of 

Cataria, fluid extract of 

Catechu 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


15-60 min. 


1.0-4.0 gm. 


15-30 min. 


1.0-2.0 gm. 


i-1 fl. dr. 


2.0-4.0 gm. 


15-30 min. 


1.0-2.0 gm. 


5-10 min. 


0.3-0.6 gm. 


2-5 gr. 


0.12-0.3 gm. 


2-5 gr. 


0.12-0.3 gm. 


5-20 min. 


0.3-1.2 gm. 


15-60 min. 


.1.0-4.0 gm. 


10 gr. 


0.6 gm. 


10-20 gr. 


0.6-1.2 gm. 


15-30 gr. 


1.0-2.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


10-30 gr. 


0.6-2.0 gm. 


1-3 gr. 


0.06-0.18 gm. 


1-2 fl. dr. 


4.0-8.0 gm. 


15-30 gr. 


1.0-2.0 gm. 


W g r - 


0.012-0.03 gm. 


15-60 min. 


1.0-4.0 gm. 


15-30 min. 


1.0-2.0 gm. 


3-10 gr. 


0.18-0.6 gm. 


15-60 min. 


1.0-4.0 gm. 


l-4fl. dr. 


4.0-16.0 gm. 


2-5 gr. 


0.12-0.3 gm. 


4-1 gr- 


0.016-0.06 gm. 


2-10 gr. 


0.12-0.6 gm. 


2-5 gr. 


0.12-0.3 gm. 


2-5 gr. 


0.12-0.3 gm. 


5-30 min. 


0.3-2.0 gm. 


i-2 fl. oz. 


16.0-64.0 gm. 


15-30 gr. 


1.0-2.0 gm. 


5-10 gr. 


0.3-0.6 gm. 


3-15 min. 


0.18-1.0 gm. 


1-3 gr. 


0.06-0.18 gm. 


i-lgr. 


0.015-0.06 gm. 


3-6 min. 


0.18-0.36 gm. 


5-20 min. 


0.3-1.2 gm. 


i~l g r - 


0.03-0.06 gm. 


2-5 min. 


0.12-0.3 gm. 


*-2 gr- 


0.03-0.12 gm. 


J-l min. 


0.03-0.06 gm. 


\-l min. 


0.015-0.06 gm. 


5-20 min. 


0.3-1.2 gm. 


1-5 min. 


0.06-0.3 gm. 


^-1 min. 


0.03-0.06 gm. 


1-2 fl. dr. 


4.0-8.0 gm. 


15-45 min. 


1.0-3.0 gm. 


1-2 fl. dr. 


4.0-8.0 gm. 


1-5 min. 


0.06-0.3 gm. 


2-8 gr. 


0.12-0.5 gm. 


2-8 gr. 


0.12-0.5 gm. 


10-30 min. 


0.6-2.0 am. 


20-30 gr. 


1.2-2.0 gm. 


1-2 fl. dr. 


4.0-8.0 gm. 


1-2 dr. 


4.0-8.0 gm. 


■ i-1 fl. dr. 


2.0-4.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


2-4 fl. dr. 


8.0-16.0 gm. 


15 min.-l fl. dr. 


1.0-4.0 gm. 


10-30 gr. 


0.6-2.0 gm. 



DOSES OF MEDICINES. 



669 



Remedy. 



Catechu, compound tincture of . . . . 

fluid extract of 

Caulophyllin 

Caulophyllum, infusion of 

Cava-cava 

Cerium nitrate 

oxalate 

Chalk, compound powder of 

mixture 

prepared 

Chamomile, oil of 

Charcoal, animal, purified 

Chelidonium majus 

extract of 

fluid extract of 

Chenopodinm, oil of 

Cherry-laurel water 

Chimaphila, fluid extract of 

Chinoidin 

Chionanthus, fluid extract of ... . 
Chiretta, fluid extract of 

tincture of , 

Chloral hydrate 

Chloralamide 

Chlorine-water . . 

Chloroform, mixture of 

purified k 

spirit of 

Chrysarobin 

Cimicifuga, fluid extract of 

tincture of 

Cinchona-bark 

aromatic fluid extract of 

compound tincture of 

extract of 

fluid extract of 

tincture of 

Cinchonia sulphate . . , 

Cinchonidia or Cinchonidine sulphate 

Cinchonine sulphate 

Cinnamon 

oil of 

spirit of 

tincture of 

Cloves. See Caryophyllus. 

Coca, fluid extract of 

leaves of 

Cocaine 

Cocculus, fluid extract of 

tincture of 

Codeine or Codeia 

Colchicine 

Colchicum, acetic extract of 

root 

extract of 

fluid extract of 

wine of 

seed 

fluid extract of 

tincture of 

wine of 



Dose. 



Apothecaries' 
Weights and Measures. 



1-2 fl. dr. 
10-30 min. 

Hgr- 

1-2 oz. 
10-30 gr. 

1-2 gr. 

1-2 gr. 
10-30 gr. 

1-2 fl. oz. 
15-30 gr. 

5-15 min. 
10-30 gr. 

|-1 dr. 

5-10 gr. 
15-30 min. 

4-8 min. 

5-30 min. 

1-2 fl. dr. 
10-30 gr. 
30-60 min. 

i-l fl. dr. 
15-60 min. 

5-20 gr. 
15-30 gr. 

1-4 fl. dr. 

l-4fl.dr. 

5-10 min. 
10 min.-l fl. dr. 

5-20 gr. 
10-30 min. 

i-l fl. dr. 
10 gr.-l dr. 
30-60 min. 

1-2 fl. dr. 
10-30 gr. 
10-30 min. 

1-2 fl. dr. 
10-20 gr. 
10-30 gr. 
10-30 gr. 

5-20 gr. 

1-5 min. 

5-20 min. 



20 min.-l fl. dr. 
i-l dr. 

1-3 min. 
2-10 min. 
1-2 gr. 

1 1_ crv 

10 50 b 1 ' 

\~\ g r - 
2-5 gr. . 

2-5 min. 
10-20 min. 

2-10 gr. 

2-8 min. 
10-30 min. 
20-40 min. 



Metric 
Svstem. 



2.0 

0.6- 
0.015- 

16.0 
0.6 

0.06- 

0.06- 
0.6- 
32- 
1.0- 
0.3- 
0.6 
2.0 
0.3- 
1.0 

0.24- 
0.3- 
4.0- 
0.6 
2.0- 
2.0- 
1.0 
0.3- 
1.0- 
4.0- 
4.0- 
0.3- 
0.6- 
0.3- 
0.6- 
2.0- 
0.6- 
2.0- 
4.0- 
0.6- 
0.6- 
8.0- 
0.6 
0.6- 
0.6- 
0.3 

0.06- 
0.3 
2.0- 

1.2- 

2.0- 

0.03- 

0.06 

0.12 

0.06- 

0.0012- 

0.015 

0.12- 

0.015- 

0.12 

0.6- 

0.12- 

0.12- 

0.6- 

1.2 



-8.0 gm. 
-2.0 gm. 
-0.03 gm 
-64.0 gm 
-2.0 gm. 
-0.12 gm 
-0.12 gm 
-2.0 gm. 
-64 gm. 
-2.0 gm 
-1.0 gm 
-2.0 gm 
-4.0 gm 
-0.6 gm 
-2.0 gm 
-0.5 gm 
-2.0 gm 
-8.0 gm 
-2.0 gm 
-4.0 gm 
-4.0 gm 
-4.0 gm 
-1.2 gm 
-2.0 gm 
-15.0 gm. 
-15.0 gm. 
-0.6 gm. 
-4.0 gm. 
-1.2 gm. 
-2.0 gm. 
-4.0 gm. 
-4.0 gm. 
-4.0 gm. 
-8.0 gm. 
-2.0 mg. 
-2.0 gm. 
-15.0 gm. 
-1.2 gm. 
-2.0 gm. 
-2.0 gm. 
-1.2 gm. 
-0.3 gm. 
-1.2 gm. 
-8.0 gm. 

-4.0 gm. 
-4.0 gm. 
-0.06 gm. 
-0.2 gm. 
-0.6 gm. 
-0.12 gm. 
-0.0006 gm. 
-0.03 gm. 
-0.3 gm. 
-0.03 gm. 
-0.3 gm. 
-1.2 gm. 
-0.6 gm. 
-0.5 gm. 
-2.0 gm. 
-2.4 gm. 



670 



DOSES OF MEDICINES. 



Remedy. 



Colocynth 

compound extract of 

extract of 

Colocynthidine 

Colocynthin 

Condurango, fluid extract of . . . 
Coniine 

hydrochlorate 

Conium, abstract of 

fluid extract of 

fruit, alcoholic extract of . . . 

fluid extract of 

tincture of 

leaves, extract of 

fluid extract of 

Convallamarin 

Convallaria, extract of 

fluid extract of 

Copaiba 

oil of 

oleo-resin of 

Copper, acetate 

ammoniated 

sulphate, astringent, tonic . . . 

emetic 

Coptis, fluid extract of 

Corrosive sublimate. See Mercury. 
Corvdalis, fluid extract of ... . 
Coto 

fluid extract of 

tincture of 

Cotoi'n 

Cotton-root bark. See Gossypium. 
Creasote 

water 

Creolin 

Croton-chloral hydrate 

Croton oil 

Cubebs 

fluid extract of 

oil of 

oleoresin of 

tincture of 

Curare 

Curarin 

Cypripedium 

fluid extract of 

Damiana, fluid extract of ... . 

tincture 

Dat urine 

Delphinium, fluid extract of . . . 

Digitaline 

Digitalis, abstract of 

extract of 

fluid extract of 

infusion of 

powder of leaves of 

tincture of 

Dioscorea, fluid extract of . . - . 

Ditn, fluid extract of 

Dogwood, bark of root 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


2-8 gr. 


0.12-0.5 gm. 


5-10 gr. 


0.3-0.6 gm. 


2-5 gr. 


0.12-0.3 gm. 


tW gr- 


0.005-0.01 gm. 


i-lgr. 


0.015-0.06 gm. 


10-30 min. 


0.6-2.0 gm. 


<rW2 gr- 


001-0.002 gm. 


e k-h gr. 


0.001-0.002 gm. 


1-2 gr. 


0.06-0.12 gm. 


5 min. 


0.3 gm. 


i-1 gr- 


0.03-0.06 gm. 


1-2 min. 


0.06-0.12 gm. 


10-20 min. 


0.6-1.2 gm. 


1-2 gr. 


0.06-0.12 gm. 


1-3 min. 


0.06-0.18 gm. 


fr-2 gr. 


0.03-0.12 gm. 


2-10 min. 


0.12-0.6 gm. 


15-30 min. 


1.0-2.0 gm. 


20 min. -1 fl. dr. 


1.2-4.0 gm. 


10-20 min. 


0.6-1.2 gm. 


2-10 gr. 


0.12-0.6 gm. 


4-1 gr- 


0.015-0.03 gm. 


i-lgr- 


0.01-0.06 gm. 


1-1 o-r 

¥ 2 gr- 


0.015-0.03 gm. 


5 gr. 


0.3 gm. 


30-60 min. 


2.0-4.0 gm. 


15-30 min. 


1.0-2.0 gm. 


1-2 gr. 


0.06-0.12 gm. 


5-15 min. 


0.3-1.0 gm. 


2-10 min. 


0.12-0.6 gm. 


tVI gr- 


0.005-0.008 gm. 


1-3 min. 


0.06-0.18 gm. 


1-4 fl. dr. 


4.0-15.0 gm. 


igr- 


0.03 gm. 


2-10 gr. 


0.12-0.6 gm. 


|-1 min. 


0.03-0.06 gm. 


10 gr.-l dr. 


0.6-4.0 gm. 


15-30 min. 


1.0-2.0 gm. 


10-20 min. 


0.6-1.2 gm. 


5-20 gr. 


0.3-1.2 gm. 


1-2 fl. dr. 


4.0-8.0 gm. 


1 1 or 

3 J 8 g 1- 


0.002-0.008 gm. 


eW? gr- 


0.001-0.002 gm. 


15 gr. 


1.0 gm. 


15-30 min. 


1.0-2.0 gm. 


30 min.-2 fl. dr. 


2.0-8.0 gm. 


1-3 fl. dr. 


4.0-12.0 gm. 


1 - 1 err 

TOO 50 g r " 


0.0006-0.0012 gm. 


1-3 min. 


0.06-0.2 gm. 


5W0 gr- 


0.001-0.002 gm. 


1-2 gr. 


0.06 0.12 gm. 


i-l gr- 


0.01-0.03 gm. 


1-6 min. 


0.06-0.35 gm. 


2-4 fl. dr. 


8.00-16.00 gm. 


'i-1 gr- 


0.03-0.06 gm. 


5-15 min. 


0.3-1.0 gm. 


15-30 min. 


1.0-2.0 gm. 


1-4 min. 


0.06-0.25 gm. 


20-60 gr. 


1.2-4.0 gm. 



DOSES OF MEDICINES. 



671 



Bemedy. 



Dogwood, fluid extract of 

Donovan's solution. See Arsenic. 

Dover's powder 

Dracontium 

fluid extract of 

Drosera, fluid extract of 

Duboisine 

Dulcamara, extract of. 

fluid extract of 

Elaterin 

Elaterium 

Emetin, diaphoretic 

emetic 

Ergot 

extract of 

fluid extract of . . 

tincture of 

wine of 

Ergotin, Bonjean's (purified extract of ergot) 

Erigeron, oil of 

Eriodictyon, extract of 

fluid extract of 

Ervthrophloein . 

Erythroxylon. See Coca. 

Eserine 

Ether, acetic 

compound spirit of (Hoffman's anodyne) 

nitrous, spirit of (sweet spirit of nitre) . 

sulphuric 

Ethyl bromide 

Eucalyptol 

Eucalyptus, fluid extract of 

oil of 

Euonymin 

Euonymus, extract of 

fluid extract of 

Eupatorium, fluid extract of 

Euphorbia pilulifera, fluid extract of . . . 

Fel bovis purificatum 

Ferrum. See Iron. 

Frangula, fluid extract of 

Galls, aromatic syrup of 

fluid extract of 

tincture of . . . 

Gamboge , 

Gaultheria, oil of 

Gelsemium, abstract of 

extract of 

fluid extract of 

tincture of . . 

Gentian, compound infusion of 

extract of 

fluid extract of 

tincture of 

Geranium, fluid extract of 

Ginger, fluid extract of 

oleo-resin of 

tincture of . . 



Dose. 



Apothecaries' 
Weights and Measures. 



Glycyrrhiza. 
Goa powder . 
Gold bromide 



30-60 min. 

5-10 gr. 
10-20 gr. 
i-l fl. dr. 
5-10 min. 

Tiro gr. 
5-10 gr. 
1-1 fl. dr. 

1 -_ 1 or 

¥0 2 g 1, 

1 1 Q.V. 

tIWo gr- 

Hr gr- 

15-60 gr. 

2-10 gr. 
15 min.-l fl. dr. 

i-2 fl. dr. 

1-3 fl. dr. 

2-8 gr.^ 

5-15 min. 

2-5 gr. 
15-30 min. 
TV! gr- 

eWo gr- 
10-20 min. 
30 min. 

i-1 fl. dr. 
15-40 min. 
15-60 min. 
10-15 min. 
15-30 min. 

5-10 min. 

2-5 gr. 

1-3 gr. 

i-l fl. dr. 

i-1 fl. dr. 

5-30 min. 

3-6 gr. 

1-2 fl. dr. 

1-2 fl. dr. 

1-2 fl. dr. 

1-2 fl. dr. 

i"4 gr. 

2-10 min. 

1-2 gr. 

1-1 gr ; 

2-5 min. 

5-10 min. 

1-4 fl. dr. 

2-3 gr. 

i-1 fl. dr. 

1-2 fl. dr. 
20-30 min. 
10-30 min. 

1-3 gr. 
15-30 min. 

5-20 gr. 
hk gr- 



Metric 
System. 



2.0-4.0 gm. 

0.3-0.6 gm. 
0.6-1.2 gm. 
2.0-4.0 gm. 
0.3-0.6 gm. 

0.0006 gm. 

0.3-0.6 gm. 

2.0-4.0 gm. 

0.001-0.003 gm. 

0.006-0.015 gm. 

0.0005-0.002 gm. 

0.008-0.015 gm. 

1.0-4.0 gm. 

0.12-0.06 gm. 

1.0-4.0 gm. 

2.0-8.0 gm. 

4.0-12.0 gm. 

0.12-0.5 gm. 

0.3-1.0 gm. 

0.12-0.3 gm. 

1.0-2.0 gm. 

0.004-0.008 gm. 



0.001-0 

0.6-1 

2 

2.0-4 

1.0-2 

1.0-4 

0.6-1 

1.0-2 

0.3-0 

0.12-0 

0.06-0 

2.0-4 

2.0-4 

0.3-2 

0.18-0 



.003 gm. 
.2 gm. 
.0 gm. 
.0 gm. 
.5 gm. 
.0 gm. 
.0 gm. 
.0 gm. 
.6 gm. 
.3 gm. 
.18 gm. 
.0 gm. 
.0 gm. 
.0 gm. 
.36 gm. 



4.0-8.0 gm. 

4.0-8.0 gm. 

4.0-8.0 gm. 

2.0-8.0 gm. 
0.03-0.25 gm. 
0.12-0.6 gm. 
0.06-0.12 gm. 
0.03-0.06 gm. 
0.12-0.3 gm. 

0.3-0.6 gm. 

4.0-8.0 gm. 
0.12-0.2 gm. 

2.0-4.0 gm. 

4.0-8.0 gm. 

1.2-2.0 gm. 

0.6-2.0 gm. 
0.06-0.18 gm. 

1.0-2.0 ^ln. 

0.3-1.2 gm. 
0.008-0.03 grr. 



672 



DOSES OF MEDICINES. 



Remedy. 



Gold and sodium chloride 

Gossypium-root, fluid extract of bark of 
Granati radicis cortex, fluid extract . . 

Grindelia, fluid extract of 

Guaiac, ammoniated tincture of . . . 

resin of 

tincture of 

Guaiacol 

Guarana 

fluid extract of 

Gurjun. See Balsam. 

Hsematoxylon 

extract of 

fluid extract of 

Hamamelis, fluid extract of 

Hedeoma, oil of 

Helleborein 

Helleborus niger, extract of 

fluid extract of 

tincture of 

Hepatica, fluid extract of 

Hops, extract of 

fluid extract of 

tincture of 

Hydrangea, fluid extract of 

Hydrastine 

Hydrastis, extract of 

fluid extract of 

tincture of 

Hyoscine hydrobromate 

Hyoscyamine sulphate 

Hyoscyamus, abstract of 

alcoholic extract of -. 

extract of 

fluid extract of flowers 

of seeds 

tincture of flowers 

of seeds 

Hypnal 

Hypnone 

Hypophosphites, syrup of 

with iron, syrup of 

Ichthyol 

Ignatia, abstract of 

extract of 

fluid extract of 

tincture of • . . 

Iodine, compound solution of ... . 

tincture of . 

Iodoform 

Iodol 

Ipecacuanha, emetic 

expectorant 

abstract of 

fluid extract of, emetic 

syrup of 

wine of, emetic 

expectorant 

Iridin or Irisin 

Iris, extract of 

fluid extract of 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


sWo g r - 


0.001-0.003 gm. 


l-l fl. dr. 


2.0-4.0 gm. 


1-2 fl. dr. 


4.0-8.0 gm. 


i-1 fl. dr. 


2.0-4.0 gm. 


30-60 min. 


2.0-4.0 gm. 


10-20 gr. 


0.6-1.2 gm. 


30-60 min. 


2.0-4.0 gm. 


4-3 gr. 


0.03-0.18 gm. 


10-30 gr. 


0.6-2.0 gm. 


10-30 min. 


0.6-2.0 gm. 


10-20 gr. 


0.6-1.2 gm. 


10-20 gr. 


0.6-1.2 gm. 


30-60 min. 


2.0-4.0 gm. 


30 min.-2 fl. dr. 


2.0-8.0 gm. 


2-5 min. 


0.12-0.3 gm. 


tVt gr- 


0.006-0.016 gm. 


1-2 gr. 


0.03-0.12 gm. 


5-15 min. 


0.3-1.0 gm. 


10-15 min. 


0.6-1.0 gm. 


30-60 min. 


2.0-4.0 gm. 


3-15 gr. 


0.2-1.0 gm. 


30-60 min. 


2.0-4.0 gm. 


1-2 fl. dr. 


4.0-8.0 gm. 


30-60 min. 


2.0-4.0 gm. 


H gr- 


0.015-0.03 gm. 


3-10 gr. 


0.2-0.6 gm. 


10-30 min. 


0.6-2.0 gm. 


30-60 min. 


2.0-4.0 gm. 


1 1 err 

Too 6 o gr- 


0.0006-0.001 gm. 


tIWo gr- 


0.0005-0.001 gm. 


2-3 gr. 


0.12-0.2 gm. 


1-2 gr. 


0.06-0.12 gm. 


2-3 gr. 


0.12-0.2 gm. 


5-15 min. 


0.3-1.0 gm. 


5 min. 


0.3 gm. 


15-30 min. 


1.0-2.0 gm. 


15-30 min. 


1.0-2.0 gm. 


4-1 gr- 


0.03-0.06 gm. 


1-5 gr. 


0.06-0.3 gm. 


1 fl. dr. 


4.0 gm. 


1 fl. dr. 


4.0 gm. 


2-4 gr. 


0.1-0.25 gm. 


1-3 gr. 


0.06-0.2 gm. 


^-1 gr. 


0.015-0.06 gm. 


1-6 min. 


0.06-0.35 gm. 


5-15 min. 


0.3-1.0 gm. 


5 min. 


0.3 gm. 


5-15 min. 


0.3-1.0 gm. 


1-3 gr. 


0.06-0.2 gm. 


f-2 gr- 


0.03-0.12 gm. 


15-30 gr. 


1.0-2.0 gm. 


f-1 gr- 


0.01-0.06 gm. 


5-30 gr. 


0.3-2.0 gm. 


15-30 min. 


1.0-2.0 gm. 


i-1 fl. dr. 


2.0-4.0 gm. 


3-6 fl. dr. 


12.0-24.0 gm. 


5-15 min. 


0.3-1.0 gm. 


1-5 gr. 


0.06-0.3 gm. 


1-3 gr. 


0.06-0.18 gm. 


5-15 min. 


0.3-1.0 gm. 



DOSES OF MEDICINES. 



673 



Remedy. 



Iron acetate, tincture of . . 

and ammonium citrate 

sulphate 

tartrate 

arsenate 

benzoate 

bitter wine of 

bromide 

syrup of 

carbonate, saccharated 

chloride 

tincture of 

and cinchonidia citrate . 

citrate 

compound mixture of . 

dialyzed. . 

solution of 

hyd rated oxide of . . . 

hypo phosphite 

syrup of 

iodide 

syrup of 

lactate 

magnetic oxide of . . . 

malate 

nitrate, solution . , . 

phosphate 

pomate 

and potassium tartrate . 

pyrophosphate 

and quinia citrate . . . 

reduced 

saccharated carbonate of 

and strychnine citrate . 

subcarbonate 

subsulphate 

sulphate 

dried 

valerianate 

wine of the citrate of. . 
Jaborandi, extract of . . . 

fluid extract of 

Jalap 

abstract of 

compound powder of . . 

extract of 

alcoholic extract of . . . 

fluid extract of 

resin of t . . 

tincture of 

Juglans, extract of ... . 

fluid extract of 

Juniperus, fluid extract of , 

Kairin 

Kamala 

fluid extract of 

Kino 

fluid extract of 

tincture of 

Kola, fluid extract of . . . 
Koosso. See Brayera 



Dose. 



Apothecaries' 
Weights and Measures. 



15-30 min. 
5-10 gr. 
5-10 gr. 
5-15 gr. 

1-5 gr. 
1-2 fl. dr. 

1-5 gr. 
15-60 min. 

5-15 gr. 

1-3 gr. 
10-30 min. 

5-10 gr. 

5-10 gr. 

1-2 fl. oz. 

5-15 min. 
10-30 min. 
Tablespoonful doses 

5-10 gr. 
1 fl. dr. 

1-5 gr. 
10-30 min. 

1-5 gr. 

5-10 gr. 

5-15 gr. 

8-15 min. 

1-5 gr. 

5-15 gr. 
10-30 gr. 

2-5 gr. 

5-10 gr. 

3-6 gr. 

5-15 gr. 

1-3 gr. 

5-30 gr. 

1-3 gr. 

1-3 gr. 

*-2 gr. 

1-3 gr. 

i-1 11. dr. 

2-5 gr. 
10-60 min. 

5-30 gr. 

5-10 gr. 
i dr. 

5-10 gr. 

3-6 gr. 
15-30 min. 

4-8 gr. 

i-2 fl. dr. 

5-20 gr. 

1-2 fl. dr. 
30-60 min. 

2-10 gr. 

1-2 dr. 
30-60 min. 
10-30 gr. 
15-30 min. 

1-2 fl. dr. 
10-30 min. 



Metric 
System. 



1.0 
0.3 
0.3 
0.3 
0.0015 

0.06 
4.0 

0.06 
1.0 
0.3 

0.06 
0.6 
0.3 
0.3 

30.0 

0.3 

0.6 

in arseni 

0.3 



0.06 
0.6 

0.06 
0.3 
0.3 
0.5 

0.06 
0.3 
0.6 

0.12 
0.3 
0.2 
0.3 

0.06 
0.3 

0.06 

0.06 

0.03 

0.06 
2.0 

0.12 
0.6 
0.3 
0.3 



0.3 

0.18 
1.0 

0.25 
2.0 
0.3 
4.0 
2.0 

0.12 
4.0 
2.0 
0.6 
1.0 
2.0 

0.65 



-2.0 gm. 

-0.6 gm. 

-0.6 gm. 

-1.0 gm. 

-0.003 gm. 

-0.3 gm. 
-8.0 gm. 
-0.3 gm. 
'-4.0 gm. 
-1.0 gm. 
-0.18 gm. 
i-2.0 gm. 
1-0.6 gm. 

-0.6 gm. 

-60.0 gm. 

-1.0 gm. 

-2.0 gm. 
ical poisoning. 

0.6 gm. 

4.0 gm. 

-0.3 gm. 

•2.0 gm. 

-0.3 gm. 

-0.6 gm. 
1-1.0 gm. 
-1.0 gm. 
-0.3 gm. 
i-1.0 gm. 
i-2.0 gm. 
-0.3 gm. 
-0.6 gm. 
!-0.4 gm. 
' -1.0 gm. 

-0.18 gm. 
1-2.0 gm. 
1-0.18 gm. 

-0.18 gm. 

-0.12 gm. 

-0.18 gm. 

-4.0 gm. 

-0.3 gm. 
-4.0 gm. 
-2.0 gm. 

-0.6 gm. 

2.00 gm. 
-0.6 gm. 

0.35 gm. 
1-2.0 gm. 
i-0.5 gm. 

-8.0 gm. 

■1.2 gm. 

-8.0 gm. 

-4.0 gm. 
-0.6 gm. 

-8.0 gm. 

-4.0 gm. 



i-2.0 gm. 
■2.0 gm. 

■8.0 gm. 
-2.0 gm. 



674 



DOSES OF MEDICINES. 



Remedy. 



Krameria 

extract of 

fluid extract of 

syrup of . . 

tincture of 

Lactucarium 

fluid extract of 

syrup of 

Lappa, fluid extract of 

Lead acetate 

iodide 

Leptandra 

extract of 

fluid extract of 

Leptandrin 

Lime, solution of 

syrup of 

Liquor potassse, soda?, etc. See Potassa, 

Soda, etc. 
Liquorice, compound mixture of 

powder of 

Lithium benzoate 

bromide 

carbonate 

citrate 

salicylate 

Lobelia, fluid extract of 

tincture of 

Lupulin 

fluid extract of 

oleoresin of 

tincture of 

Magnesia 

Magnesium carbonate 

sulphate 

sulphite 

Male fern, oleoresin of 

Malt, extract of 

Manganese binoxide 

sulphate 

Manna 

Matico 

fluid extract of 

tincture of 

Matricaria, fluid extract of 

Menispermum, fluid extract of 

Menthol 

Mercury with chalk 

corrosive chloride of 

cyanide 

formamidate (1 per cent, solution) . . . 

green iodide of 

mass of (blue pill) 

mild chloride of 

red iodide of . . - 

salicylate 

tannate 

yellow subsulphate of 

Mezereum, extract of 

fluid extract of 

Morphine and its salts 



Dose. 



Apothecaries' 
Weights and Measures. 



10-20 gr. 

5-15 gr. 
20-30 min. 

1-4 fl. dr. 

£-2 fl. dr. 
10-15 gr. 
10-30 min. 

1-3 fl. dr. 
30-60 min. 

i-3 gr. 

1-3 gr. 
20-40 gr. 

3-10 gr. 
30-60 min. 

2-4 gr. 

1-4 dr. 
15-30 min. 



1 

1. 

2 

5- 
2 
2 
2 
2 
1 

10 
5 

10 
2 
i. 

2 

10- 

10 gr, 

2 dr. 

10 

30 min, 

1 

2 

2- 

1- 



Tir 
5- 
i. 

3- 
i 

T 
1 

32 

1 
2 



4 fl. dr. 
-ldr. 
-10 gr. 
-10 gr. 
-10 gr. 
-10 gr. 
-10 gr. 
-5 min. 
-30 min. 
-10 gr. 
-15 min. 
-5gr. 
-2 fl. dr. 
-30 gr. 
-ldr. 
-1 oz. 
-30 gr. 
-1 fl. dr. 
-2 fl. dr. 
-4 gr. 
-10 gr. 
-2 oz. 
-2 dr. 
-1 fl. dr. 
-2 fl. dr. 
-30 min. 
-60 min. 
2gr. 
-10 gr. 

T6 g r - 
i gr. m 
-15 min. 
4 gr. 
10 gr. 
-5gr. 

-re gr- 
-1 gr. 
-1 gr. 
-1 gr. 
-1 gr. _ 
-10 min. 
ig r - 



Metric 
System. 



0.6-1.2 gm. 

0.3-1.0 gm. 

1.2-2.0 gm. 

4.0-16.0 gm. 

2.0-8.00 gm. 

0.6-1.0 gm. 

0.6-2.0 gm. 

4.0-12.0 gm. 

2.0-4.0 gm. 
0.03-0.18 gm. 
0.03-0.18 gm. 

1.2-2.5 gm. 
0.18-0.6 gm. 

2.0-4.0 gm. 
0.12-0.25 gm. 

4.0-15.0 gm. 

1.0-2.0 gm. 



4.0-16.0 gm. 

2.0-4.0 gm. 

0.3-0.6 gm. 
0.12-0.6 gm. 
0.12-0.6 gm. 
0.12-0.6 gm. 
0.12-0.6 gm. 
0.06-0.3 gm. 

0.6-2.0 gm. 

0.3-0.6 gm. 

0.6-1.0 gm. 
0.12-0.5 gm. 

2.0-8.0 gm. 

0.6-2.0 gm. 

0.6-4.0 gm. 

8.0-32.0 gm. 

0.6-2.0 gm. 

2.0-4.0 gm. 

4.0-8.0 gm. 
0.12-0.25 gm. 
0.12-0.6 gm. 
32.0-64.0 gm. 

2.0-8.0 gm. 

2.0-4.0 gm, 

2.0-8.0 gm. 

0.6-2.0 gm. 

2.0-4.0 gm. 

0.12 gm. 

0.12-0.6 gm. 

0.002-0.004 gm. 

0.004-0.008 gm. 

0.3-1.0 gm. 
0.01-0.03>m. 

0.2-0.6 gm. 

0.008-0.3 gm. 

0.002-0.004 gm. 

0.03-0.06 gm. 

0.03-0.06 gm. 

0.015-0.06 gm. 

0.03-0.06 urn. 

0.18-0.6 gm. 

0.004-0.03 gm. 



DOSES OF MEDICINES. 



675 



Remedy. 



Morrhuol 

Musk 

tincture of 

Myrrh 

tincture of 

Myrtol 

Naphthaline 

Naphthol 

Narceine 

Narcotine 

Nectandra, fluid extract of 

Nitroglycerin (1 per cent, solution) .... 
Nux vomica, abstract of 

extract of 

fluid extract of 

tincture of 

Opium, camphorated tincture of (paregoric) 

confection of 

extract of 

powder 

tincture of (laudanum) 

wine of 

Pancreatin , . . . . 

Papaver, extract of 

fluid extract of 

Papayotin 

Paracotoin 

Paraldehyde 

Pareira 

extract of 

fluid extract of 

tincture of 

Pelletierine sulphate 

tannate 

Peppermint, oil of 

spirit of 

Pepsin, pure . 

liquor of . ". 

saccharated .... - 

Petroselinum, fluid extract of 

Phenacetin 

Phosphorated oil 

Phosphorus 

Physostigma, extract of . 

fluid extract of 

tincture of 

Physostigmine salicylate 

sulphate 

Phytolacca, abstract of 

berries, fluid extract of 

root, extract of 

fluid extract of 

tincture of 

Phytolaccin 

Picrotoxin 

Pilocarpine and its salts 

Pilocarpus, abstract of 

fluid extract of 

Pimenta, fluid extract of 

Piper methysticum, fluid extract of . . . . 

nigrum, fluid extract of 



Dose. 



Apothecaries' 
Weights and Measures. 



1-5 gr. 

2-15 gr. 
15-60 min. 
10-30 gr. 
15-30 min. 

2-3 gr. 

2-10 gr. 

2-10 gr. 

*-* gr. 

3gr. 
1-4 fl. dr. 

1 min. 
i-1 gr. 

i-i gr : 

1-5 min. 
10-20 min. 

i-2 fl. dr. 
10-40 gr. 

M g r - 

i-lgr.. 

5-15 min. 

5-15 min. 
10-20 gr. 

*-2 gr- 

15-30 min. 

1-5 gr. 

1-3 gr. 
20-60 min. 

i-l dr. 
10-30 gr. 

i-1 fl. dr. 
1 fl. dr. 

2-5 gr. 

1-5 gr. 

2-5 min. 
30-60 min. 
15 gr.-l dr. 

2-4 fl. dr. 
90 gr.-| oz. 

1-2 fl. dr. 

2-5 gr. 

3-5 min. 
■th-fs gr- 
tW gr- 

1-3 min. 

5-10 min. 
T20~ sV gr- 
jhs-fo gr- 

5-15 gr. 

5-30 min. 

1-3 gr. 

5-30 min. 
10-60 min. 

2-3 gr. 
eW^gr. 
eW gr- 

5-20 gr. 

15-60 min. 

15-45 min. 

15 min.-l fl. dr. 

15-45 min. 



Metric 
System. 



0.06-0.3 gm. 

0.1-1.0 gm. 

1.0-4.0 gm. 

0.6-2.0 gm. 

1.0-2.0 gm. 
0.12-0.18 gm. 
0.12-0.6 gm. 
0.12-0.6 gm. 
0.01-0.03 gm. 
0.18 gm. 

4.0-16.0 gm. 

0.06 gm. 

0.015-0.06 gm. 

0.008-0.03 gm. 

0.06-0.3 gm. 

0.6-1.2 gm. 

2.0-8.0 gm. 

0.6-2.5 gm. 

0.01-0.03 gm. 

0.015-0.06 gm. 

0.3-1.0 gm. 

0.3-1.0 gm. 

0.6-1.2 gm. 
0.03-0.12 gm. 

1.0-2.0 gm. 
0.06-0.3 gm. 
0.06-0.18 gm. 

1.2-4.0 gm. 

2.0-4.0 gm. 

0.6-2.0 gm. 

2.0-4.0 gm. 

4.0 gm. 

0.12-0.3 gm. 

0.06-0.3 gm. 

0.12-0.3 gm. 

2.0-4.0 gm. 

1.0-4.0 gm. 

8.0-15.0 gm. 

2.0-16.0 gm. 

4.0-8.0 gm. 

0.12-0.3 gm. 

0.18-0.3 gm. 

0.0006-0.0008 gm. 

0.004-0.01 gm. 

0.06-0.18 gm. 

0.3-0.6 gm. 
0.0005-0.0008 gm. 
0.0005-0.0008 gm. 

0.3-1.00 gm. 
0.12-2.0 gm. 
0.06-0.18 gm. 

0.3-2.0 gm. 

0.6-4.0 gm. 

0.12-0.18 gm. 

0.001-0.002 gm. 

0.001-0.03 gm. 

0.3-1.2 gm. 

1.0-4.0 gm. 

1.2-3.0 gm. 

1.0-4.0 gm. 

1.0-3.0 gm. 



676 



DOSES OF MEDICINES. 



Kemedy. 



Piper nigrum, oleoresin of ... . 

Piperine 

Piscidia erythrina, extract of . . 

fluid extract of 

powder of 

Podophyllum, abstract of 

resin of 

Pomegranate, bark of 

Poppy. See Papaver. 

Potassa, solution of (liquor potassse) 

Potassium acetate 

bicarbonate . 

bitartrate 

bromide 

carbonate 

chlorate 

citrate 

solution of 

cyanide 

ferrocyanide 

hypophosphite 

iodide 

mixture of the citrate of ... . 

nitrate 

permanganate 

and sodium tartrate 

sulphate 

sulphide 

sulphite 

tartrate 

Prinos 

fluid extract 

Pulsatilla, fluid extract of 

Pyrethrum, tincture of 

Pyridine 

Pyrodine 

Quassia, extract of 

fluid extract of 

tincture of 

Quebracho, fluid extract of ... . 

Quercus, fluid extract of 

Quinidine 

Quinine and salts 

arsenate 

Quinoidin 

Resorcin 

Rhamnus catharticus, fluid extract of 
Rhubarb 

aromatic syrup of 

tincture of 

compound powder of 

extract of 

fluid extract of 

and soda, mixture of . . . . . . 

sweet tincture of 

syrup of 

tincture of 

wine of 

Rhus, aromatic fluid extract of . . . 

glabra (cortex), fluid extract of . 
(fructus), fluid extract of . . . 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


1-3 gr. 


0.06-0.2 gm. 


1-8 gr. 


0.06-0.5 gm. 


1-2 gr. 


0.06-0.12 gm. 


10-30 min. 


0.6-2.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


1-5 gr. 


0.6-0.3 gm. 


Hgr- 


0.008-0.03 gm. 


20-30 gr. 


1.2-2.0 gm. 


5-20 min. 


0.3-1.2 gm. 


15 gr.-l dr. 


1.0 4.0 gm. 


10-40 gr. 


0.6-2.5 gm. 


1-5 gr. 


0.06-0.3 gm. 


10 gr.-l dr. 


0.6-4.0 gm. 


5-30 gr. 


0.3-2.0 gm. 


5-1 5 gr. 


0.3-1.0 gm. 


15-60 gr. 


1.0-4.0 gm. 


2-4 fl. dr. 


8.0-16.0 gm. 


tW gr- 


0.004-0.008 gm. 


10-15 gr. 


0.6-1.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


2-15 gr. 


0.12-1.0 gm. 


|- fl. oz. 


15.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


1-2 gr. 


0.06-0.12 gm. 


i-1 oz. 


15.0-30 gm. 


30 gr.-2 dr. 


2.0-8.0 gm. 


1-10 gr. 


0.06-0.6 gm. 


15-30 gr. 


1.0-2.0 gm. 


1 dr.-l oz. 


4.0-32.0 gm. 


30 gr.-l dr. 


2.0-4.0 gm. 


30-60 min. 


2.0-4.0 gm. 


2-5 min. 


0.12-0.3 gm. 


10-30 min. 


0.6-2.0 gm. 


1-3 gr. 


0.06-0.18 gm. 


1-3 gr. 


0.06-0.18 gm. 


1-5 gr. 


0.06-0.3 gm. 


30-60 min. 


2.0-4.0 gm. 


|-2 fl. dr. 


2.0-8.0 gm. 


20-60 min. 


1.2-4.0 em. 


30-60 min. 


2.0-4.00 gm. 


1-30 gr. 


0.06-2.0 gm. 


1-30 gr. 


0.06-2.0 gin. 


i-1 gr. 


0.01-0.06 gm. 


10-30 gr. 


0.6-2.0 gm. 


5-10 gr. 


3-0.6 gm. 


30-60 min. 


2.0-4.0 gm. 


2-30 gr. 


0.12-2.0 urn. 


1-4 fl. dr. 


4.0-16.0 gm. 


i-l fl. dr. 


2.0-4.0 gm. 


i-l dr. 


2.0-4.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


15-40 min. 


1.0-2.5 gm. 


i-l fl. dr. 


2.0-4.0 gm. 


1-4 fl. dr. 


4.0-16.0 gm. 


1-4 fl. dr. 


4.0-16.0 gm. 


1-4 fl. dr. 


4.0-16.0 gm. 


1-2 fl. dr. 


4.0-S.O gm. 


15-60 min. 


1.0-4.0 gm. 


30-60 min. 


2.0-4.0 gm. 


30-60 min. 


2.0-4.0 gm. 



DOSES OF MEDICINES. 



677 



Remedy. 



Rhus toxicodendron 

Eoses, fluid extract of 

syrup of 

Eubus, fluid extract of 

Eumex, fluid extract of 

Euta, fluid extract of 

Sabina, fluid extract of 

Saccharin 

Salicin 

Salix, fluid extract of 

Salol . . . 

Salvia, fluid extract of < . 

Sambucus, fluid extract of 

Sandal-wood, oil of 

Sanguinaria 

fluid extract of 

tincture of 

Santonica 

fluid extract of 

Santonin 

Sarsaparilla, compound fluid extract of 

compound syrup of 

fluid extract of 

Sassafras, fluid extract of 

Savine, oil of 

Scammony 

resin of 

Scoparius, fluid extract of 

Scutellaria, fluid extract of 

Scutellarine 

Senega, abstract of 

fluid extract of 

syrup of 

Senna 

compound infusion of 

confection of 

fluid extract of 

infusion of 

syrup of 

tincture of 

Serpentaria, fluid extract of ... . 

tincture of 

Silver iodide . 

nitrate ... 

oxide 

Simaruba, fluid extract of 

Soda, solution of (liquor sodse) .... 
Sodium acetate 

arsenate 

benzoate 

bicarbonate 

bisulphite 

borate 

bromide 

carbonate 

chlorate. . 

citrate 

hypophosphite • . . 

hyposulphite 

iodide 

nitrite 



Dose. 



Apothecaries' 
Weights and Measures. 



1-6 min. 

i-2 fl. dr. 

1-2 fl. dr. 

i-2 fl. dr. 
30-60 min. 
15-30 min. 

5-15 min. 

1-4 gr. 
10-30 gr. 

i-2 fl. dr. 
10-20 gr. 

i-2 fl. dr. 

\-2 fl. dr. 
15-20 min. 

1-5 gr. 

5-10 min. 
10-40 min. 
10-30 gr. 
15-60 min. 

1-4 gr. 

1-2 fl. dr. 

1-4 fl. dr. 

|-2 fl. dr. 

i-2 fl. dr. 

2-5 min. 

5-15 gr. 

2-10 gr. 

1-1 fl. dr. 

1-2 fl. dr. 

1-3 gr. 

4-10 gr ; 

8-15 min. 

1-2 fl. dr. 
10-60 gr. 

1-2 oz. 

1-2 dr. 

1-4 fl. dr. 
4 fl. oz. 



dr. 

oz, 
dr. 
dr. 



1-4 fl 

2 fl. dr.-l fl 

30 min.-l fl 

1-2 fl 

l~2 gr. 

£-1 g r - 
15-30 min 
5-20 min 
15 gr.-l dr. 

eWo gr- 

5-30 gr. 
10-30 gr. 
10-30 gr. 
10-30 gr. 
10-30 gr. 
10-30 gr. 

5-30 gr. 

1-10 dr. 

5-15 gr. 
10-30 gr. 

5-20 gr. 

1-4 gr. 



Metric 

System. 



0.06-0.4 gm. 

2.0-8.0 gm. 

4.0-8.0 gm. 

2.0-8.0 gm. 

2.0-4.0 gm. 

1.0-2.0 gm. 

0.3-1.0 gm. 
0.03-0.25 gm. 

0.6-2.0 gm. 

2.0-8.0 gm. 

0.6-1.2 gm. 

2.0-8.0 gm. 

2.0-8.0 gm. 

1.0-1.2 gm. 
0.06-0.3 gm. 

0.3-0.6 gm. 

0.6-2.5 gm. 

0.6-2.0 gm. 

1.0-4.0 gm. 
0.06-0.25 gm. 

2.0-8.0 gm. 

4.0-16.0 gm. 

2.0-8.0 gm. 

2.0-8.0 gm. 
0.12-0.3 gm. 

0.3-1.0 gm. 
0.12-0.6 gm. 

2.0-4.0 gm. 

4.0-8.0 gm. 
0.06-0.18 gm. 
0.25-0.6 gm. 

0.5-1.0 gm. 

2.0-8.0 gm. 

0.6-4.0 gm. 
32.0-64.0 gm. 

4.0-8.0 gm. 

4.0-15.0 gm. 
125.0 gm. 

4 0-16.0 gm. 

8.0-30.0 gm. 

2.0-4.0 gm. 

2.0-8.0 gm. 

0.03-0.12 gm. 

0.015-0.03 gm. 

0.03-0.06 gm. 

1.0-2.0 gm. 

0.3-1.2 gm. 

1.0-4.0 gm. 
0.001-0.006 gm. 

0.3-2.0 gm. 

0.6-2.0 gm. 

0.6-2.0 gm. 

0.6-2.0 gm. 

0.6-2.0 gm. 

0.6-2.0 gm. 

0.3-2.0 gm. 

4.0-40.0 gm. 

0.3-1.0 gm. 

0.6-2.0 gm. 

0.3-1.2 gm. 
0.06-0.25 gm. 



678 



DOSES OF MEDICINES, 



Remedy. 



Sodium phosphate 

salicylate 

sulphate 

sulphite 

Sparteine sulphate 

Spigelia, fluid extract of . . . . 

and senna, fluid extract of . . 
Squill, compound fluid extract of 
syrup of 

fluid extract of 

syrup of 

tincture of 

Stillingia, fluid extract of . . . 
Stramonium, extract of . . 

fluid extract of 

leaves, alcoholic extract of . 
tincture of 

seeds, extract of 

tincture of 

Strontium bromide 

iodide 

lactate 

phosphate 

Strophanthus, tincture of . . . 

Strophantin 

Strychnine and its salts .... 

Sulphonal 

Sulphur 

Sumbul, fluid extract of ... . 

tincture of 

Taraxacum, extract of ... . 

fluid extract of 

Terebene 

Terpine hydrate 

Terpinol 

Thallin, sulphate of 

tartrate of 

Theine . . . . • . . 

Thuja, fluid extract of ... . 

Thymol 

Toxicodendron, fluid extract of 
Triticum, fluid extract of . . . 

Turpentine, oil of 

Urethane 

Ustilago maidis, fluid extract of 
TJva ursi, fluid extract of . . . 
Valerian, abstract of 

ammoniated tincture of . . - 

extract of 

fluid extract of 

oil of 

tincture of 

Veratrine 

Veratrum viride, abstract of . . 

fluid extract of 

tincture of 

Verbena, fluid extract of . . . 
Viburnum, fluid extract of . . 
Vinegar. See Acetum. 
Wahoo. See Euonymus. 
Wild-cherry bark 



Dose. 



Apothecaries' 


Metric 


Weights and Measures. 


System. 


2-10 gr. 


0.12-0.6 gm. 


10-20 gr. 


0.6-1.2 gm. 


1-4 dr. 


4.0-16.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


ifc gr. 


0.002 gm. 


15-60 min. 


1.0-4.0 gm. 


1-2 fl. dr. 


2.0-8.0 gm. 


5-30 min. 


0.3-1.8 gm. 


15-30 min. 


1.0-2.0 gm. 


5-30 min. 


0.3-1.8 gm. 


1-1 fl. dr. 


2.0-4.0 gm. 


10-60 min. 


0.6-4.0 gm. 


15-60 min. 


1.0-4.0 gm. 


igr- 


0.03 gm. 


1-4 min. 


0.06-0.25 gm. 


1_1 o-r 
? 2 g r - 


0.015-0.03 gm. 


8-15 min. 


0.5-1.0 gm. 


\~\ g r - 


0.015-0.03 gm. 


6-15 min. 


0.4-1.00 gm. 


20-30 gr. 


1.2-2.0 gm. 


10-20 gr. 


0.6-1.2 gm. 


20-30 gr. 


1.2-2.0 gm. 


20-30 gr. 


1.2-2.0 gm. 


3-8 min. 


0.2-0.5 gm. 


T^o-eV g r - 


0.0005-0.001 gm. 


eWe g r - 


0.001-0.004 gm. 


15-30 gr. 


1.0-2.0 gm. 


1-3 dr. 


4.0-12.0 gm. 


15-60 min. 


1.0-4.0 gm. 


10-30 min. 


0.6-2.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


1-1 fl. dr. 


2.0-4.0 gm. 


5-10 min. 


3-0.6 gm. 


2-5 gr. 


0.12-0.3 gm. 


2 J o gr- 


0.003 gm. 


1-5 gr. 


0.06-0.3 gm. 


1-5 gr. 


0.06-0.3 gm. 


1-2 gr. 


0.06-0.12 gm. 


10-15 gr. 


0.6-1.0 gm. 


1-5 gr. 


0.06-0.3 gm. 


1-5 min. 


0.06-0.3 gm. 


1-2 fl. dr. 


4.0-8.0 gm. 


5-30 min. 


0.3-2.0 gm. 


10-30 gr. 


0.6-2.0 gm. 


15-60 min. 


1.0-4.0 gm. 


1-1 fl. dr. 


2.0-4.0 gm. 


10-15 gr. 


0.6-1.0 gm. 


1-2 fl. dr. 


2.0-8.0 gm. 


5-15 gr. 


0.3-1.0 gm. 


1-1 fl. dr. 


2.0-4.0 gm. 


4-5 min. 


0.24-0.3 gm. 


1-2 fl. dr. 


2.0-8.0 gm. 


1 1 o-r 

63 20 g r " 


0.001-0.003 gm. 


1-2 gr. 


0.06-0.12 gm. 


1-5 min. 


0.06-0.3 gm. 


3-5 min. 


0.18-0.3 gm. 


15-60 min. 


1.0-4.0 gm. 


1-2 fl. dr. 


4.0-8.0 gm. 


i-l dr. 


2.0-4.0 gm. 



DOSES OF MEDICINES. 



679 



Remedy. 



Wild-cherry bark, fluid extract of . 

infusion of 

syrup of 

Wintergreen, oil of 

Worrnseed, oil of ........ . 

Xanthoxylum bark, fluid extract of. 

fruit, fluid extract of 

Zinc acetate 

bromide 

iodide 

oxide 

phosphide 

sulphate (alterative) 

(emetic) 

syrup of iodide of 

valerianate . . . .- 

Zingiber. See Ginger. 



Dose. 



Apothecaries' 
Weights and Measures. 


Metric 
System. 


30-60 min. 


2.0-4.0 gm. 


1-2 fl. oz. 


30.0-60.0 gm. 


2-4 fl. dr. 


8.0-16.0 gm. 


1-20 min. 


0.06-1.2 gm. 


4-8 min. 


0.24-0.5 gm. 


15-30 min. 


1.0-2.0 gm. 


15-30 min. 


1.0-2.0 gm. 


1-2 gr. 
i-2 gr. 


0.06-0.12 gm. 
0.03-0.12 gm. 


i-8 gr. 

2-8 gr. 


0.03-0.18 gm. 
0.12-0.5 gm. 


4-1 gr. 


0.003-0.006 gm. 
0.015-0.06 gm. 


10-30 gr. 


0.6-2.0 gm. 


20-40 min. 


1.2-2.5 gm. 


1-4 gr. 


0.06-0.2 gm. 



TABLES OF RELATIVE WEIGHTS AND MEASURES IN THE 
METRIC AND APOTHECARIES' SYSTEMS. 

(See Oldberg's Manual of Weights and Measures.) 







Milligrammes 


in Grains. 






Milligramme 
0.1 

0.2 

0.3 
0.4 
0.5 
0.6 
0.7 
0.8 


= 


Grain. 

BlJo 
l 

"SOU 

MO 

TWO 

1 
T20- 

1 
100 

1 
80 


Milligrammes. 

1 = 

1.2 == 
1.6 = 

2 = 

3 = 

4 = 

5 = 
6 


Grain. 

l 

60 
1 

zo 

i 

40 

1 

"50 

i 


Milligrammes. 

8 = 

9 = 
10 = 
12 = 
16 = 
20 = 
30 = 
60 = 


Grain 

l 

8 

T 
1 
6 
1 
5 
1 
4 
1 
3 
1 
2" 

1 


0.9 


= 


1 
TO" 


7 


= 


* 












c 


ENTIGRAMMES 


in Grain 


3. 






Centigrammes 
(or Cent.) 
1 


Grain. 

1 

6 


Centigrammes, 
(or Cent.) 

6 = 


Grains. 
1 


Centigrammes 

(or Cent.) 

18 


Grain 

3 


2 


= 


1. 
3 


7 


= 


1* 


25 


= 


4 


3 


= 


I 


9 


= 


H 


50 


= 


8 


4 


= 


2 
3" 


10 


= 


if 


75 


= 


12 


5 


= 


f 


12 


= 


2 


100 


= 


16 








Grammes in 


Grains. 








Grammes. 




Grains. 


Grammes. 




Grains. 


Grammes. 




Grains. 


0.001 


= 


eV 


11 


= 


176 


27 


= 


432 


0.010 


= 


l 

6 


12 


= 


192 


28 


= 


448 


0.100 


= 


1 2 


13 


= 


208 


29 


= 


464 


0.250 


= 


4 


14 


= 


224 


30 


= 


480 


0.500 


= 


8 


15 


= 


240 


31 


= 


496 


0.750 


= 


12 


16 


= 


256 


32 


= 


512 


1 


= 


16 


17 


= 


272 


33 


= 


528 


1.50 


=: 


24 


18 


= 


288 


34 


= 


544 


2 


= 


32 


19 


= 


304 


35 


= 


560 


3 


= 


48 


20 


= 


320 


36 


= 


576 


4 


= 


64 


21 


= 


336 


37 


= 


592 


5 


= 


80 


22 


= 


352 


38 


= 


608 


6 


= 


96 


23 


= 


368 


39 


= 


624 


7 


= 


112 


24 


= 


384 


40 


= 


640 


8 


= 


128 


25 


= 


400 


50 


= 


800 


9 


= 


144 


26 


= 


416 


100 


= 


1600 


10 


= 


160 















681 



682 



RELATIVE WEIGHTS AND MEASURES. 



Cubic Centimetres (or Fluidgrammes) in U. S. Apothecaries' 
Fluidrachms. 



Cubic 
Centimetres. 
1 
2 
3 
4 
5 
6 
7 



U.S. 
Fluidrachrns. 



= 2 



Cubic 
Centimetres. 

9 
10 
11 
12 
13 
14 
15 



U.S. 
Fluidrachrns. 



H 



Cubic 
Centimetres. 
16 
20 
24 
28 
32 
48 
64 



U.S. 
Fluidrachrns. 

4 

5 

6 

7 

8 
12 
16 



INDEX OF DRUGS AND REMEDIAL MEASURES. 



ABOETIFACIENTS, 29 
Absorption of drugs, 26 
Abstracts, 22 
Acacia, 39 
Acacire gumrni. 39 
Aceta, 22 
Acetanilid, 39 
Acetate of ammonium, 61 

of copper, 169 

of lead, 235 

of morphine, 283 

of potassium, 43 

of sodium, 328 

of zinc, 44 
Acetic acid. 44 
Acetphenetidine, 292 
Acetum cantharidis, 115 

lobelia?, 241 

opii, 282 

sanguinarire, 320 

scillse, 223, 332 
Acid infusion of roses, 311 

nitrate of mercury, 256 

tartrate of potassium, 92 
Acidum aceticum, 44 
dilutum, 44 
glaciale, 44 

arsenosum, 77-80 

benzoicum, 90 

carbolicum, 117 

liquefactum, 121 

cbromicum, 146 

citricum, 155 

gallicum, 192 • 

hydrobromicum dilutum, 100 

bydrochloricum dilutum, 205 

hydrocyanicum, 206 

nitricum, 266 
dilutum, 268 

nitro-hvdrochloricum, 205, 269 
dilutum, 205, 269 

phosphoricum dilutum, 295 

salicylicum, 313 

sulphuricum, 340 
aromaticum, 341 
dilutum, 341 

tannicum, 343 

tartaricum, 345 

tricbloraceticum, 349 

valerianicum, 353 
Aconite, 45 

liniment, 47 

ointment, 47 
Aconiti folia, 47 

radix, 47 
Aconitine, 47 
Action of drugs, direct, 19 
duration of, 27 



Action of drugs, indirect, 19 

modes of, 19 
Acupuncture, 359 
Adeps benzoinatus, 90 

lana3 hydrosus, 232 
Adhesive plaster, 308 
Administering drugs, mode of, 19 
Adonidin, 48 
Adonis vernalis, 48 
.Ether, 182 
Agaric, 48 
Agaricin, 48 
Alcohol, 48, 53 

absolutum, 48 

amylicum, 48-53 

deodoratum, 48 

dilutum, 48-53 

ethylicum, 48 

phenvlic, 117 
Ale, 53 
Alkaloids, 22 
Allium, 53 
Allspice, 54 
Almond bread, 411 
Almonds, 54 

bitter, 54 

sweet, 54 
Aloe, 55 

barbadensis, 55. 

purificata, 56 

socotrina, 55 
Aloin, 55 
Alteratives, 29-35 
Alum, 57 
Alumen, 57 

exsiccatum, 58 
Amber, 58 

American wormseed, 128 
Ammonia, 59 

liniment, 61 
Ammoniac, 64 
Ammoniacum, 64 
Ammoniated mercury, 250 

tincture of guaiac, 198 
of valerian, 353 
Ammonii acetas, 61 

benzoas, 61 

bromidum, 62 

carbon as, 62 

chloridum, 63 

iodidum, 63 

oxalas, 64 

phosphas, 64 

sulphas, 64 

sulphis, 64 

valerianas, 64 
Ammouio-ferric alum, 224 
Ammonium, 61 

683 



684 



INDEX OF DRUGS. 



Amygdala amara, 54 

dulcis, 54 
Amyl nitrite, 64 
Aroylic alcohol, 48-53 
Amylum, 333 
Anaesthetics, 29-35 
Anaphrodisiacs, 29 
Antacids, 29-35 
Anthelmintics, 29-35 
Anthrarobin, 66 
Antiarthritics, 29 
Antidotum arsenici, 81, 227 
Antifebrin, 39 
Antihydrotics, 29 
Antimonial powder, 69 
Antimonii et potassii tartras, 66 

oxidum, 66 

sulphidum, 66 

puriflcatum, 66 
Antimonium nigrum puriflcatum, 66 

sulphuratum, 66 

tartaratum, 66 
Antimony, 66 
Antiperiodics, 29-35 
Antiphlogistics, 29-35 
Antipyretics, 35 
Antipyrine, 70 
Antiseptics, 360 
Antispasmodics, 36 
Antitoxin, 486 
Aphrodisiacs, 29 
Apiol, 75 

Apomorphinse hydrochloras, 76 
Apomorphine, 75 
Aqua ammonia}, 60 
fortior, 60 

amygdalae amarse, 55 

camphorse, 116 

chloroformi, 145 

cinnamomi, 154 

creosoti, 171 

hydrogenii dioxidi, 207 

menthse piperitse, 289 

pimentse, 54 

rosse, 311 
Aqua-, 23 
Arbutin, 352 
Argent! et potassii nitras, 266 

nitras, 263 
fusus, 263 
dilutus, 266 
Aristol, 76 
Arnica, 76 

flores, 76 

radix, 76 

rhizoma, 76 
Aromatic chalk powder, 107 
with opium, 107 

mixture of iron, 224 

powder, 154 

spirit of ammonia, 61 

sulphuric acid, 341 

syrup of rhubarb, 310 

tincture of rhubarb, 310 
Arsenate of copper, 77 

of iron, 225 

of potassium, 77 

of sodium, 77 
Arsenic, 77 
Arsenicum, 77 
Arseni iodidum, 80 
Arsenous acid, 77 



Asafcetida, 82 
Aspidium, 82 
Astringents, 29-36 
Atomization, 21 
Atropinse sulphas, 84-88 
Atropine, 84-88 
Auri et sodii chloridum, 197 
Azedarach, 83 

BALM OF GILEAD," 350 
Balsam of copaiba, 167 
Barbadoes aloes, 55 
Barium chloride, 83 
Barley-water, 410 
Basham's mixture, 225 
Bath, Russian, 389 

Turkish, 387 
Bearberry, 352 
Beechwood creosote, 170 
Beef essence, 410 

peptonized, 407 

tea, 409 
Beer, 53 
Belladonna, 84 

folia, 84 

liniment, 88 

ointment, 88 

plaster, 88 

radix, 84 
Benzoate of ammonium, 61 

of bismuth, 89 

of lithium, 239 
Benzoated lard, 90 
Benzoic acid, 89 
Benzoin, 89 
Benzoinum, 89 
Berberine, 204 
Beta-napthol, 263 
Bicarbonate of potassium, 90 

of sodium, 90 
Bichloride-carbolic acid solution, 36S 
Bichloride of mercury, 250 

as an antiseptic, 360 
Bimuriate of quinine and urea, 152 
Biniodide of mercury, 252 
Binoxide of manganese, 243 
Bismuth, 91 

benzoate, 89 

salicylate, 312 

subgallate, 92 
Bismuthi carbonas, 91 

citras, 91 

et ammonii citras, 91 

subcarbonas, 91 

subnitras, 91 
Bismuthum, 91 
Bisulphate of quinine, 152 
Bitartrate of potassium, 92 
Bitter almonds, 54 

wine of iron, 229 
Bitters, 30 
Black cohosh, 147 

draught, 325 

drop, 282 

ginger, 195 

mustard, 261 

oxide of manganese, 243 

pepper, 288 

snake-root, 147 

wash, 252 
Blaud's pill, 225 
Bleeding, 404 



INDEX OF DRUGS. 



685 



Blood-root, 319 
Blue mass, 252 

ointment, 255 

pill, 252 
Boneset, 189 
Bonjean's ergotin, 181 
Boric acid, 93 
Borate of sodium, 93 
Borated lint, 94 
Borax, 93 
Boroglycerin, 95 
Bran bread, 411 
Brandy, 53 
Brayera, 173 
Bromide of ammonium, 62, 

of calcium, 99 

of gold, 99 

of ethyl, 186 

of iron, 225 

of lithium, 99, 239 

of nickel, 99 

of potassium, 95 

of sodium, 99 

of strontium. 334 
Bromides, 95 
Bromine, 100 
Bromoform. 100 
Bronchitis tents, 446 
Broom, 323 
Brown mixture, 238 
Brucine, 272 
Brvonia, 101 
Buchu, 102 

folia, 102 
Burgundy pitch, 303 
Burnt alum, 58 
Butyl-chloral hydras, 172 



pACTUS grandiflorus, 102 
\J Caffeinre citrata, 103 
effervescens, 103 
Caffeine, 103 
Cajuput oil, 104 
Calabar bean, 29 
Calabarine, 298 
Calcii bromidum, 99-105 

carbonas prsecipitatus, 105 

chloridum, 105 

hydras, 108 

hypophosphis, 105 

phosphas prsecipitatus, 105 
Calcium, 104 
Calcined magnesia, 241 
California buckthorn, 123 
Calomel, 252 

ointment, 254 
Calumba, 107 
Calumbine, 107 
Calumbo, 107 
Calx, 107 

chlorata, 135 

cblorinata, 135 

sulphurata, 108, 337 
Camphor, 108 

liniment, 110 
Camphor-water, 110 
Campbora monobromata, 110 
Camphorated tincture of opium, 281 
Camphoric acid, 111 
Canada pitch, 303 
Cannabis Americana, 111 



Cannabis Indica, 111 
Cantharidal cerate, 115 

collodion, 115, 165 

liniment, 115 

paper, 115 
Cantharidin, 114 
Cantharis, 114 
Capsici fructus, 115 
Capsicum, 115 

fruit, 115 

plaster, 117 
Carbo ligni, 121 
Carbolic acid, 117 

as an antiseptic, 361 

ointment, 120 
Carbon, 121 

disulphide, 122 
Carbonate of ammonium, 62 

of bismuth, 90 

of iron, 225 

of lead, 236 

of lithium, 239 

of magnesium, 242 

of potassium, 122 

of zinc, 122 
Cardamom, 123 

seed, 123 
Cardiac sedatives, 30-36. 

stimulants, 30-36 
Carlsbad salt, artificial, 521 
Carminative powder, 154 
Carminatives, 30 
Carron oil, 108 
Caryophyllus, 156 
Cascara cordial, 124 

sagrada, 123 
Cassia fistula, 124 
Cassia? pulpa, 124 
Cathartics, 30 
Castile soap, 326 
Castor oil, 124 
Cataplasma carbonis, 121 

conii, 167 

lini, 191 

sinapis, 261 
Cataplasms, 23 
Catechu, 126 
Cat's-hair, 189 
Caustic potash, 127 

soda, 127 
Cayenne pepper, 115 
Cerates, 23 
Ceratum camphors?, 110 

cantharidis, 115 

plumbi subacetatis, 237 

resina, 308 
Cerii oxalas, 127 
Chalk, 106 

mixture, 105 
Champagne, extra dry, 52 
Charcoal, 121 

poultice, 121 
Charta cantharidis, 115 

epispastica, 115 

potassii nitratis, 263 

sinapis, 261 
Charta?, 23 
Chenopodium, 128 
Chimaphila, 128 
Chinoidinum, 153 
Chirata. 128 
Chiretta, 128 



686 



INDEX OF DRUGS. 



Chloral. 129 

hydras, 129 
Chloralamide, 131 
Chloralose, 132 
Chlorate of potassium, 133 
Chloride of ammonium, 63 

of barium, 83 

of calcium, 105 

of gold and sodium, 197 

of iron, 225 

of mercury, corrosive, 250 

of mercury, mild, 252 

of sodium, 135 

of zinc, 134 

as an antiseptic, 365 
Chlorinated lime, 135 
Chlorine gas, 135 
Chlorodyne, 136 
Chloroform, 136 

liniment, 146 
Chloroform-water, 140 
Chloroformum, 136 
Cholagogues, 30 
Chromic acid, 146 
Chrysophanic acid, 309 
Chrysarobin, 147 

ointment, 147 
Cimicifuga, 147 

racemosa, 147 

rhizoma, 147 
Cinchona, 148 

calisaya, 148 

condaminea, 148 

cortex, 148 

micrantha, 148 

pale, 148 

pitayensis, 148 

red, 148 

rubra, 148 

cortex, 148 

succirubra, 148 

yellow, 148 
Cinch onicine, 148 
Cinchonidine, 148-153 
Cinchonidinse sulphas, 153 
Cinch onidinum, 153 
Cinchoninse sulphas, 153 
Cinch on ine, 153 
Cinnamon, 154 
Cinnamon-water, 154 
Cinnamomum cortex, 154 
Citrate of bismuth, 91 

of bismuth and ammonium, 91 

of caffeine, 103 

of iron, 226 

of iron and ammonium, 226 

of iron and quinine, 226 

of iron and strychnine, 226 

of lithium, 239 

of magnesium, 242 

of potassium, 154 
Citric acid, 155 
Citrine ointment, 257 
Clarets, 53 

Classification of drugs, 35 
Climates, 399 
Cloves, 156 
Clyster, 20 

Cobalto-nitrite of potassium, 268 
Coca, 156 

Cocainse hydrochloras, 156 
Cocaine, 156 



Cocaine phenate, 159 
Codeine, 159 
Cod-liver oil, 160 
Coffee, 103 
Colchicine, 163 ' 
Colchicum, 163 
corms, 163 
Colchicum-seed, 163 
Cold as a remedy, 366 
cream, 311 
pack, 375 
Collodion, 164 
Collodium, 164 

cantharidatum, 115, 165 
flexile, 164 
stypticum, 164, 344 
vesicans, 165 
Colocynth, 165 
Colocynthidis pulpa, 165 
Cologne-water, 53 
Colu mbo, 107 

Combination of drugs for joint effect, 33 
Commercial oxide of zinc, 284 
Compound cathartic pill, 165 
effervescing powder, 324 
decoction of aloes, 57 

of sarsaparilla, 321 
extract of colocynth, 165, 322 
fluid extract of sarsaparilla, 321 
infusion of gentian, 194 

of senna, 244 
liniment of camphor, 110 

of mustard, 262 
mixture of iron, 225 
of liquorice, 238 
of senna, 325 
pill of antimony, 70 
of asafoetida, 82 
of colocynth, 165 
of conium, 167 
of rhubarb, 310 
of scammony, 323 
of soap, 282 
of squill, 333 
powder of almonds, 55 
of catechu, 127 
of chalk, 107 
of cinnamon, 154 
of elaterin, 179 
of ipecac, 223, 282 
of jalap, 230 
of kino, 232 
of liquorice, 238 
of morphine, 283 
of opium, 282 
of rhubarb, 310 
of scammony, 323 
solution of iodine, 218 
spirit of ether, 201 
of juniper, 231 
suppositories of lead, 236 
syrup of sarsaparilla, 321 

of squills, 332 
tincture of benzoin, 90 
of camphor, 110 
of cardamom, 123 
of catechu, 127 
of chloroform, 146 
of cinchona, 153 
of gentian, 194 
Condurango, 166 
Confectio opii, 282 



INDEX OF DRUGS. 



687 



Confectio piperis, 288 

rosae, 203, 311 

scamrnonii, 322 

sennse, 124, 325 

sulphuris, 340 

terebinthinse, 352 
Confections, 23 
Conii folia, 166 

fructus, 166 
Coniine, 166 
Conium, 166 
Conserves, 22 

Contraindications for drugs, 29 
Convailaria, 167 
Copaiba, 167 
Copper, 168 
Corrosive chloride of mercury, 250 

sublimate, 250 
Cosmoline, 291 
Counter-irritants, 31-36 
Counter-irritation, 376 
Coxe's hive syrup, 332 
Cream of tartar, 92 
Creosote, 170 
Creolin, 171 

as an antiseptic, 364 
Creta prseparata, 106 
Croton chloral, 172 

oil, 172 

, liniment, 172 
Cubebic acid, 173 
Cubebin, 173 
Cubebs, 173 
Cupri acetas, 169 

nitras, 169 

sulphas, 169 
Cuprum, 168 
Cusso, 173 
Cyanide of potassium, 174 



DANDELION, 345 
Daturine, 334 
Decoctions, 23 

Decoctum aloes compositum, 57 
cinchonse, 153 
granati radicis, 306 
hsernatoxyli, 200 
pareirse, 287 
quercus, 308 
sarsse, 322 

compositum, 322 
sarsaparillee compositum, 321 
scoparii, 324 
taraxaci, 344 
Definition of therapeutics, 18 
Demulcents, 31 
Deodorized opium, 281 

tincture of opium, 282 
Dermatol, 92 
Diachylon, 237 
Dialyzed iron, 226 
Diaphoretics, 31-36 

Diet for child six to twelve months old, 
408 

one year old, 408 
two years old, 408 
seven vears old, 408 
lists, 408 
Diethyl-sulphon-dimethyl -methane, 337 
Digestants, 36 
Digested gruel, 408 



Digitalin, 178 
Digitalis, 174 

folii, 178 
Dilute acetic acid, 44 

alcohol, 48 

hydrobromic acid, 100 

hydrochloric acid, 205 

hydrocyanic acid, 206 

nitric acid, 268 

nitro-hydrochloric acid, 269 

phosphoric acid, 295 

solution of subacetate of lead, 236 

sulphuric acid, 341 
Dimethyloxyquinizine, 70 
Disinfectants, 36 
Disinfection, 379 
Disulphide of carbon, 122 
Diuretics, 31-37 
Diuretin, 327 
Dobell's solution, 93 
Donovan's solution, 80 
Dosage, 24 

Double cyanide dressing, 365 
Dover's powder, 223, 282 
Dried alum, 58 

sulphate of iron, 229 
Drugs, absorption of, 26 

classification of, 35 

duration of action of, 27 

indications and contraindications for, 
29 

modes of administering, 19 

strength and reliability of, 27 
Duboisine, 178 



ECBOLIC acid, 179 
Ecgonine, 156- 
Eifervescing citrate of caffeine, 103 
of lithium, 239 

draught, 155 

powder, 91 

solution of lithium, 239 
"Egg-flip," 53 
Egg-nog, 52 
Elaterin, 178 
Elaterium, 178 
Electuaries, 22 
Eliminators, 31-37 
Elixir phosphori, 297 

roborans, 153 
Elixirs, 23 
Emetics, 31-37 
Emetine, 223 
Emmenagogues, 31-37 
Emplastra, S3 

Emplastrum ammoniaci cum hydrargyro, 
61 

arnicse, 77 

asafoetidse, 82 

belladonna, 89 

califaciens, 115 

cantharidis, 115 

capsici, 117 

ferri, 229 

hydrargvri, 256 

menthol^ 290 

opii, 282 

peroxidum ferri, 229 

picis burgundicre, 303 
canadensis, 303 
cantharidatum, 115 



688 



INDEX OF DRUGS. 



Emplastrum plumbi, 237 
iodidi, 236 

resina?, 308 

saponis, 327 
Emulsum amnioniaci, 61 

asafcetida, 82 

chloroformi, 146 
Emulsion of bitter almonds, 55 

of sweet almonds, 55 
Endermic medication, 22 
Enema, 20 

aloes, 57 

asafcetidae, 82 

magnesii sulphatis, 243 

opii, 282 

terebinthina?, 352 
Enteroclysis, 381 
Ergot, 179 
Ergotic acid, 179 
Ergotin, 179 
Ergotinum, 181 
Erigeron, 181 
Erythroxylon, 156 
Eserine, 297 

Essentia mentha? piperita?, 289 
Etber, 182 
Ethyl alcohol, 48 

bromide, 186 

iodide, 187 
Eucalyptol, 189 
Eucalyptus, 188 
Euonymin, 189 
Euonymus, 189 
Eupatorium, 189 
Euphorbia pilulifera, 189 
Europhen, 190 
Exalgine, 190 
Expectorants, 32-37 
Extracts, 23 
Extractum aconiti, 47 

aloes aquosum, 56 
barbadensis, 57 
socotrina?, 57 

arnica? radicis, 77 

belladonna? foliorum alcoholicum, 88 

belladonna? radicis fluidum, 88 

calumba?, 107 

cannabis indica?, 113 

cascara? sagrada?, 124 

cimicifugse, 148 

cinchona?, 153 

colchici, 164 

acetic urn, 164 
radicis, 164 

colocynthidis, 165 

compositum, 165, 322 

conii, 166 

digitalis, 178 

ergota?, 181 

euonymi, 189 

gentiana?, 194 

glycyrrhiza?, 238 
purum, 238 

heematoxyli, 200 

hyoscyami, 209 

jaborandi, 302 

jalapre, 230 

krameria?, 232 

leptandra?, 237 

lupuli, 204 

mezerei a?thereum, 260 

nucis vomica?, 275 



Extractum opii, 281 

pareira?, 287 

physostigmatis, 299 

podophylli, 305 

quassia?, 308 

rhei, 310 

stramonii seminis, 334 

taraxaci, 341 
. uva ursi, 352 
Extractum belladonna? alcoholicum, 

conii alcoholicum, 166 

gelsemii alcoholicum, 194 

hyoscyami alcoholicum, 209 
Extractum aconiti fluidum, 47 

arnica? radicis fluidum, 77 

belladonna? radicis fluidum, 88 

buchu fluidum, 102 

calumba? fluidum, 107 

cannabis indica? fluidum, 114 

capsici fluidum, 116 

cascara sagrada? fluidum, 124 

chimaphila? fluidum, 128 

chirata? fluidum, 128 

cimicifuga? fluidum, 148 

cinchona? fluidum, 153 

coca? fluidum, 158 

colchici radicis fluidum, 164 
seminis fluidum, 164 

conii fluidum, 166 

convallaria fluidum, 167 

cubeba? fluidum, 173 

cusso fluidum, 174 

digitalis fluidum, 178 

ergota? fluidum, 181 

eucalypti fluidum, 189 

eupatorii fluidum, 189 

gelsemii fluidum, 194 

gentiana? fluidum, 194 

gerar.ii fluidum, 195 

glycyrrhiza? fluidum, 238 

grindelipe fluidum, 198 

hamamelidis fluidum, 201 

hydrastis fluidum, 205 

hyoscyami fluidum, 209 

ipecacuanha? fluidum, 223 

kola? fluidum, 232 

krameria? fluidum, 282 

leptandne fluidum, 237 

lobelhe fluidum, 241 

lupulini fluidum, 204 

nucis vomica? fluidum, 275 

pareira? fluidum, 287 

pilocarpi fluidum, 301 

podophylli fluidum, 305 

pruni Virgiuiana? fluidum, 307 

quassia? fluidum, 308 

rhamui Purshiana? fluidum, 124 

rhei fluidum, 310 

rhois glabra? fluidum, 311 

rosa? fluidum, 311 

sabina? fluidum, 322 

sauguiuaria? fluidum, 320 

sarsaparilla? fluidum, 322 
compositum, 321 

scilla? fluidum, 332 

scopavii fluidum, 324 

senega? fluidum, 324 

senna? fluidum, 325 

serpeiitaria? fluidum, 326 

solanum carolinense, 329 

spigelia? fluidum, 331 

et senna? fluidum, 331 



INDEX OF DRUGS. 



689 



Extractum stillingias fluidum, 333 

stramonii seminis fluidum, 334 

taraxaci fluidum, 345 

uvas ursi fluidum, 352 

Valerianae fluidum, 352 

veratri viridis fluidum, 356 

zingiberis fluidum, 195 
Extractum cascarae sagradse liquidum, 124 

cinchonas liquidum, 153 

cocas liquidum, 181 

ergotse liquidum, 181 

filicis liquidum, 83 

glycyrrhizse liquidum, 238 

hamamelidis liquidum, 201 

hydrastis liquidum, 205 

opii liquidum, 282 

pareiras liquidum, 287 

sarsse liquidum, 322 

IflEL BOVIS, 284 
purificatum, 284 
Ferri arsenas, 225 

bromidum, 225 

carbonas saccharatus, 225 

chloridum, 226 

citras, 226 

et ammonii citras, 226 
sulphas, 224 
tartras, 226 

et potassii tartras, 226 

et quininse citras, 226 
solubilis, 226 

et strychninse citras, 226 

iodidum saccharatum, 227 

lactas, 227 

oxalas, 228 

oxidum hydratum, 227 

cum magnesia, 81, 227 

peroxidum hydratum, 229 

phosphas solubilis, 228 

pyrophosphas solubilis, 228 

subsulphatis, 228 

sulphas, 229 

exsiccatus, 229 
granulatus, 229 
prsecipitatus, 229 

valerianas, 229 
Ferruin, 220 

dialysatum, 226 

reductum, 228 

tartaratum, 226 
Filix mas, 82 
Flaxseed, 191 

meal, 191 

oil, 191 

poultice, 191 

tea, 191 
Fleabane, 181 

Flemming's tincture of aconite, 47 
Flexible collodion, 164 
Flowers of sulphur, 339 
Fluid extracts, 23 
Flying blister, 377 
Foods for the sick, 406 
Foot-bath, 386 
Fowler's solution, 80 
Fusel oil, 48 



GALLA. 192 
Gallic acid, 192 
ointment, 192 

44 



Garlic, 53 

Gaultheria, 192 

Gelsemine, 193 

Gelsemium, 193 

General therapeutic considerations, 17 

Gentian, 194 

Gentianae radix, 194 

Geranium, 195 

German chamomile, 244 

soft soap, 327 
Germicides, 379 

Germs, mode of destroying, 379 
Gin, 53 
Ginger, 195 
Glacial acetic acid, 44 
Glauber's salt, 329 
Glycerin, 195 
Glycerins, 20 
Glycerita, 23 

Glyceritum acidi carbolici, 121 
gallici, 192 
tannici, 344 

aluminis, 197, 58 

amyli, 197 

boracis, 94 

boroglycerini, 95 

hydrastis, 205 

plumbi subacetatis, 197 

tragacanthse, 197 

vitelli, 197 
Glycyrrhiza, 238 
Glycyrrhizas radix, 238 
Glycyrrhizinum ammoniatum, 239 
Goa powder, 147 
Gold, 197 

bromide of, 99 
Goodell's sumbul pill, 342 
Goulard's extract, 236 
Granatum, 305 

Granulated citrate of magnesium, 242 
Gray oil, 255 

powder, 255 
Green iodide of mercury, 257 

soap, 327 
Griffith's mixture, 225 

pills, 225 
Grindelia, 197 
Guaiac, 198 

wood, 198 
Guaiaci lignum, 198 

resina, 198 
Guaiacol, 198 
Gum acacia, 39 

arabic, 39 
Gurjun balsam, 200 

oil, 200 



H.EMATOXYLI LIGNUM, 200 
Hsematoxylon, 200 
Hamamelis, 200 
Heat, 385 

Heavy magnesium, 242 
Hemlock-fruit, 166 
Hemlock-leaves, 166 
Henbane, 208 
Hoffmann's anodyne, 201 
Homatropine hydrobromat'e, 202 
Home modification of Turkish bath, 387 
Honey, 203 

of borax, 94 

of rose, 203, 311 



690 



INDEX OF DRUGS. 



Honey of squill, 333 

Hop poultice, 203 

Hope's camphor mixture, 204 

Hops, 203 

Horse nettle, 329 

House mixture, 326 

Humulus, 203 

Husband's magnesia, 241 

Huxham's tincture, 153 

Hydrargyri chloridum mite, 252 

iodidum flavum, 257 
rubrum, 252 

oxidum flavum, 257 
rubrum, 257 

perchloridum, 250 

subcbloridum, 252 

subsulphas flavus, 257 
Hydrargyrum, 244 

ammoniatum, 250 

cbloridum corrosivum, 250 

cum creta, 255 
Hydrastine, 204 
Hydrastis, 204 
Hydrate of chloral, 129 

of lime, 135 
Hydrated oxide of iron with magnesium, 
227 

peroxide of iron, 229 

sesquioxide of iron, 227 
Hydriodic acid, 219 
Hydrobromate of homatropine, 202 

of hyoscine, 210 

of hyoscyamine, 209 

of quinine, 152 
Hydrobromic acid, 100 
Hydrobromide of coniin, 166 
Hydrochlorate of apomorphine, 76 

of cocaine, 156 

of morphine, 283 

of pilocarpine, 301 

of quinine, 152, 153 
Hydrochloric acid, 205 
Hydrocyanic acid, 206 
Hydrogen peroxide, 207 

as an antiseptic, 365 
Hyoscine, 209 
Hyoscyami folia, 208 
Hyoscyaminae sulphas vel hydrobromas, 

209 
Hyoscyamine, 208 
Hyoscyamus-leaves, 208 
Hypnal, 210 
Hypnotics, 32 
Hypodermic medication, 20 

injection of apomorphine, 75 
Hypodermoclysis, 390 
Hypophosphite of calcium, 105 

of sodium, 327 
Hyposulphite of sodium, 329 



TCE JACKET, 368 
1 poultice, 368 
Ichthyol, 210 
Idiosyncrasy, 24 
Incompatibilities, 33 
Indian hemp, 111 

poke, 354 
Indications for drugs, 29 
Infusions, 23 
Infusum brayerse, 174 

buchu, 102 



Infusum calumbse, 107 

caryophylli, 156 

catechu, 127 

chiratre, 129 

cinchona, 153 
acidum, 153 

columbse, 107 

cusso, 174 

digitalis, 178 

ergotse, 181 

gentianse compositum, 194 

jaborandi, 302 

kramerise, 232 

lini, 191 

lupuli, 204 

pruni Virginians, 307 

quassise, 308 

rhei, 310 

rosse acidum, 311 

sennse, 325 

compositum, 244 

senegse, 325 

serpentaria, 326 

uvse ursi, 352 

Valeriana?, 353 
Inhalations, 20 
Injectio apomorphina? hypodermica, 76 

ergotini hypodermica, 181 

morphinse hypodermica, 283 
Intravenous iujection, 391 
Inunctions, 22 
Iodide of ammonium, 63 

of arsenic, 80 

of ethyl, 187 

of iron, 227 

of lead, 236 

of potassium, 212 

of sodium, 214 

of strontium, 334 

of thymol, 348 
Iodine, 214 

liniment, 218 

ointment, 219 
Iodoform, 221 

as an antiseptic, 363 

ointment, 219 
Iodol, 221 
Iodum, 214 
Ipecac, 221 
Iron, 22S 

plaster, 229 



JABORANDI, 299 
Jaborin, 299 
Jalap, 230, 322 
Jalapin, 230 
Jamaica dogwood, 29 
Jamestown weed, 334 
James's powder, 69 
Jequirity, 230 
Jervine, 354 

Joint effects of drugs, 28 
Juniper, 231 
Junket, 412 



KAMALA, 231 
Kataphoresis, 392 
Kerrnes mineral, 66 
Kino, 232 
Kola, 232 



INDEX OF DRUGS. 



691 



Koosin, 173 
Kousso, 173 
Koumyss, 408 
Krameria, radix, 232 
Kreolin, 364 



LACTATE OF IRON, 227 
of strontium, 334 
Lactose, 336 

Lady Webster dinner pills, 56 
Lamellae atropine, 89 

cocaine, 158 

pbysostigruine, 299 
Lanolin, 232 
Laudanine, 276 
Laudanum, 282 
Laughing gas, 270 
Lavage, 392 
Lavements, 20 
Lead, 233 

plaster, 237 
Lead-water and laudanum, 236 
Leeches, 394 
Leeching, 394 

Ledoyen's disinfectant solution, 237 
Lemon-juice, 155 
Leptandra, 237 
Levant wormseed, 320 
Light magnesia, 242 
Lignum vitse, 198 
Lime, 107 
Lime-water, 108 
Lini farina, 191 

semina, 191 
Linimentum aconiti, 47 

ammonise, 61 

belladonnse, 88 

calcis, 108 

camphora?, 110 

compositum, 110 

cantharidis, 115 

chloroformi, 146 

crotonis, 173 

hvdrargyri, 256 

iodi, 218 

opii, 282 

potassii iodidi cum sapone, 214 

plumbi subacetatis, 237 

saponis, 110, 327 

sinapis compositum, 262 

terebinthinse, 352 
aceticum, 352 
Linseed, 191 

poultice, 191 
Linum, 191 
Lipanin, 238 
Liquor acidi arsenosi, 80 

chromici, 146 

ammonise, 61 
acetatis, 61 
fortior, 64 

ammonii citratis, 64 
fortior, 64 

antimonii chloridi, 80 

arseni et hydrargyri iodidi, 80 

arsenicalis, 80 

arsenici hydrochloricus, 80 

atropine sulphatis, 89 

bismuthi et ammonii citras, 91 

calcis, 108 



Liquor calcis chlorinate, 135 
saccharatus, 108 
carbonis detergens, 495 
epispasticus, 115 
ferri acetatis, 229 

et ammonii acetatis, 225 

fortior, 229 
chloridi, 226 
citratis, 226 
dialysatus, 227 
perchloridi, 226 
fortior, 226 
subsulphatis, 228 
tersulphatis, 80 
hydrargyri nitratis, 256 

perchloridi, 252 
iodi, 218 

compositus, 218 
lithie effervescens, 240 
magnesii carbonatis, 242 

citratis, 242 
morphine acetatis, 283 
hydrochloratis, 283 
sulphatis, 283 
pepsini, 290 
plumbi subacetatis, 236 

dilutus, 236 
potasse, 239 
potassii arsenitis, 80 
citratis, 155 
permanganas, 291 
sode, 127 
sodii arsenatis, 80 

silicatis, 326 
zinci chloridi, 134 
Liquorice, 238 
Liquorice-root, 238 
Lister's dressing, 365 
Litharge, 237 
Lithia-water, 239 
Lithii bezoas, 239 

bromidum, 99, 239 
carbonas, 239 
citras, 239 
effervescens, 239 
salicylas, 239 
Lithium, 239 
Lobelia, 240 
Logwood, 200 
Lotio hydrargyri flava, 257 

nigra, 252 
Lozenges, 23 
Lugol's solution, 218 
Lunar caustic, 263 
Lupuline, 203 
Lupulus, 203 
Lvcopodium, 247 
Lysol, 241 



MACE, 271 
Magendie's solution, 283 
Magnesia, 241 
levis, 241 
ponderosa, 241 
Magnesii carbonatis, 242 
citras, 242 

effervescens, 242 
carbonas levis, 242 
ponderosa, 242 
sulphas, 242 
Magnesium, 242 



692 



INDEX OF DRUGS. 



Male fern, 82 
Mandrake, 305 
Manganese, 243 
Mangani dioxidurn, 243 

sulphas, 243 
Manganum, 243 
Manna, 243 
Massa copaibse, 168 

ferri carbonatis, 225 

hydrargyri, 252 
Matricaria, 244 
May apple, 305 
Meconic acid, 276 
Meconine, 276 
Mel, 203 

boracis, 94 

depuratum, 203 

despumatum, 203 

rosse, 203, 311 
Mentha piperita, 288 
Menthol, 289 
Mercurial ointment, 255 

oleate, 256 

pills, 252 

plaster, 256 

suppositories, 256 
Mercury, 244 

with chalk, 255 
Methyl acetanilid, 190 

blue, 258 

chloride, 259 

salicylatis, 192 

violet. 258 
Methylene blue, 259 

chloride, 260 
Mezerei cortex, 260 
Mezereum, 260 

ointment, 260 
Mild chloride of mercury, 252 
Milk of asafoetida, 81 

of sulphur, 339 

-punch, 52, 406 

peptonized, 406 

-sugar, 336 
Mineral springs, 396 
Mint camphor, 289 

stearopten, 289 
Mistura creosoti, 171 

cretse, 105 

ferri aromatica, 224 

ferri composita, 225 

glycyrrhizse composita, 238 

guaiaci, 198 

potassii citratis, 155 

rhei et soda?, 310 

scammonii, 322 

sennas composita, 325 

spiritus vini gallici, 53 
Mitigated caustic, 266 
Mode of action of drugs, 19 
Mode of administering drugs, 19 
Monkshood, 45 

Monobroniate f camphor, 110 
Monsel's salt, 228 

solution, 228 
Morphinse acetas, 283 

hydrochloras, 283 

sulphas, 283 
Morphine, 283 
Moschus, 260 
Mucilage of acacia, 39 
Mucilago acacise, 39 



Mulled wine, 52, 412 

Muriate of ammonium, 63 
of morphine, 283 

Musk, 261 

Mustard, 261 
papers, 261 
plaster, 261, 378 

Mydriatics, 32 

Myotics, 32 

Myristica, 271 

Myrrh, 262 



ATAPHTHALIN, 262 
1M Naphtol, 263 
Narceine, 276 
Narcotine, 276 
Nervous sedatives, 37 

stimulants, 32-38 
Neutral mixture, 155 
Nicotine, 348 
Nickel, bromide of, 99 
Nitrate of copper, 169 

of lead, 237 

of mercury, 256 

of pilocarpine, 302 

of potassium, 263 

of silver, 263 
Nitre, 263 
Nitric acid, 266 
Nitrite of amyl, 64 

of potassium, 268 
Nitroglycerin, 268 
Nitro-hydroehloric acid, 205, 269 
Nitrous oxide, 270 
Norwood's tincture of veratrum viride» 



356 
Nut-gall, 192 
Nutmeg, 271 
Nux vomica, 272 



OIL of tar, 304 
of vitriol, 340 
Ointment of aconite, 47 

of ammoniated mercury, 250 

of antimony, 69 

of atropine, 89 

of belladonna, 89 

of calomel, 254 

of cantharides, 115 

of carbolic acid, 120 

of carbonate of lead, 236 

of chrysarobin, 147 

of creosote, 171 

of eucalyptus, 189 

of gallic acid, 192 

of galls, 192 

with opium, 192 
of iodide of lead, 236 

of potassium, 214 
of iodine, 218 
of iodoform, 221 
of lead acetate, 236 
of mercury, 255 
of mezereum, 260 
of nitrate of mercury, 257 
of oxide of zinc, 284 
of petrolatum, 291 
of red iodide of mercury, 252 

oxide of mercury, 257 



INDEX OF DRUGS. 



693 



Ointment of resin, 308 

of rose-water, 311 

of salicylic acid, 317 

of savine, 322 

of stramonium, 334 

of sulphur, 340 

of tannic acid, 344 

of tar, 304 

of tartrate of antimony, 69 

of turpentine, 352 

of veratrine, 354 

of yellow oxide of mercury, 257 
Ointments, 24 
Oleatum hydrargyri, 257 

veratrinse, 354 
Oleoresina aspidii, 83 

capsici, 115 

cubebse. 173 

lupulini, 204 

piperis, 288 

zingiberis, 195 
Oleum amygdalae amarse, 54 
expressum, 55 

cajuputi, 104 

caryophylli, 156 

chenopodii, 128 

cinereum, 247 

cinnamomi, 154 

copaibse, 168 

crotonis, 172 

cubebse, 173 

erigerontis, 181 

eucalypti, 189 

gaultherise, 193 

jecoris aselli, 160 

juniperi, 231 

lini, 191 

menthse piperitse, 289 

morrhuse, 160 

myristicse, 272 

picis liquida?, 304 

pimentse, 54 

pbosphoratum, 297 

riciui, 124 

rutse, 312 

sabinse, 322 

santali, 319 

sinapis, 261 

volatile, 261 

succini, 58 

tanacetum, 344 

terebinthinse, 350 
rectificatum, 350 

tiglii, 172 

valerinange, 352 
Opium, 275 

deodorated, 281 
Opodeldoc, 327 
Oxalate of ammonium, 64 

of cerium, 127 

of iron, 228 
Ox-gall, 284 
Oxide of antimony, 66 

of calcium, 107 

of lead, 237 

of mercury, 257 

of zinc, 284 
Oxygen, 285 
Oxygen-water, 285 ■ 
Oxymel, 203 

scillse, 333 
Oxytoxics, 32-38 



PALE CINCHONA, 148 
rose, 311 
Pancreatin, 286 
Papain, 286 
Papaverine, 276 
Papayotin, 286 
Papers, 22 
Papoid, 286 
Paraldehyde, 286 
Paregoric, 281 
Pareira, 287 
Pareirse radix, 287 
Parsley, 75 

Pearson's solution, 80 
Pelletierine, 305 
Pental, 287 
Pepo, 288 
Pepper, 288 
Peppermint, 288 
Peppermint-water, 289 
Pepsin, 290 

Pepsinum saccharatum, 290 
Peptonized beef, 407 

enema, 407 

gruel, 408 

milk, 406 

punch, 406 

oysters, 407 
Permanganate of potassium, 290 
Peroxide of hydrogen, 207 
Petrolatum, 291 

liquidum, 291 

molle, 291 

spissum, 291 
Petroselinum, 75 
Phenacetin, 292 
Phenate of cocaine, 159 
Phenic acid, 117 
Phenocoll, 294 
Phenol, 117 
Phenozone, 70 

Phenyldimethylpyrazolon, 70 
Phenvlic alcohol, 117 
Phlebotomy, 404 
Phosphate of ammouium, 64 

of iron, 228 

of -sodium, 294 

of strontium, 334 
Phosphide of zinc, 295 
Phosphorated oil, 297 
Phosphoric acid, 295 
Phosphorus, 295 
Physostigma, 297 
Physostigmatis semen, 297 
Physostigmina, 297 
Physostigniinae salicylas, 299 

sulphas, 299 
Physostigmine, 297 
Pill of three valerianates, 353 
Pills, 23 
Pilocarpine hydrochloras, 301 

nitras, 302 
Pilocarpine, 299 
Pilocarpus, 299 
Pilula asafoetidse composita, 82 

colocynthidis composita, 165 
et hyoscyami, 165 

conii composita, 167 

ferri carbonatis, 225 

hydrargyri, 252 

ipecacuanhas cum scilla, 223 

phosphori, 297 



69 



INDEX OF DRUGS. 



Pilula plumbi cum opio, 236 

saponis composita, 282 

scammonii composita, 323 

scilla? composita, 333 
Pilulse aloes, 56 

et asafoetidse, 56, 81 
et ferri, 56 
et mastiches, 56 
et myrrha?, 56, 262 

antimonii composita?, 70 

asafoetida?, 82 

cathartica? composita?, 165 

ferri carbon atis vegetabilis, 165 
iodidi, 227 

opii, 281 

phosphori, 297 

rhei, 310 

composite, 310 
Pimenta, 54 
Pinkroot, 331 
Piper, 288 

nigrum, 288 
Piperazine, 302 
Piperine, 288 
Pipsissewa, 128 
Piscidia erythrina, 303 
Pitcb, 303 
Pix, 303 

burgundica, 303 

canadensis, 303 

liquida, 304 
Plaster of ammoniac witb mercury, 61 

of arnica, 77 

of asafcetida, 82 

of belladonna, 89 

of Burgundy pitcb, 303 

of Canada pitcb, 303 

of cantbarides, 115 

of capsicum, 117 

of iodide of lead, 236 

of iron, 229 

of lead, 237 

of mentbol, 89 

of mercury, 256 

of opium, 282 

of resin, 308 

of soap, 327 

of tar, 303 
Plasters, 23 
Plumbi acetas, 235 

carbonas, 236 

iodidum, 236 

nitras, 237 

oxidum, 237 
Plumbum, 233 
Plummer's pills, 70 
Podopbylli rbizoma, 305 
Podophyllum, 305 
Poke-root, 354 
Polygalic acid, 325 
Pomegranate, 305 
Port wine, 53 
Porter, 53 
Potash papers, 263 
Potassa, 127 

caustica, 127 

cum calce, 127 
Potassii acetas, 43 

bicarbonas, 90 

bitartras, 92 

bromidum, 95 



Potassii carbonas, 122 

chloras, 133 

citras, 154 

effervescens, 155 

cyanidum, 174 

iodidum, 212 

nitras, 263 

permanganas, 290 

et sodii tartras, 311 

tartras acida, 92 
Precipitated carbonate of calcium, 105 
of zinc, 122 

pbospbate of calcium, 105 

sulphate of iron, 229 

sulphur, 339 
Prepared chalk, 106 
Pride of China, 83 
Proof spirit, 53 
Protiodide of mercury, 257 
Primus Virginiana, 306 
Prussic acid, 206 
Pseudomorphine, 276 
Pulvis amygdalae compositus, 55 

antimonialis, 69 

aromaticus, 154 

catechu compositus, 127 

cinnamomi compositus, 154 

creta? aromaticus, 107 
cum opio, 107 

compositus, 107 

effervescens compositus, 324 

elaterini compositus, 179 

glycyrrhiza? compositus, 238, 325 

ipecacuanha? compositus, 223 
et opii, 223, 282 

jalapa? compositus, 230 

kino compositus, 232 

niorphina? compositus, 283 

opii, 281 

compositus, 282 

rhei compositus, 310 

scammonii compositus, 323 
Pumpkin-seed, 288 
Punch, milk-, 52 
Punk, 48 

Purging cassia, 124 
Purified aloes, 56 

ox-gall, 284 

sulphide of antimony, 66 
Pyoktanin, 258 
Pyridine, 348 
Pyrogallic acid, 307 
Pyrogallol, 307 
Pyrophosphate of iron, 228 



QUASSIA, 307 
Quassia? lignum, 307 
Queen's root, 333 
Quercus alba, 308 

tinctoria, 308 
Quevenne's iron, 228 
Quicksilver, 244 
Quinicine, 140 
Quinidina? sulphas, 153 
Quiniua? bimuriatica carbamas, 152 

bisulphas, 152 

hydrobromas, 152 

hydrochloras, 152 

valerianas, 153 

quinine, 148 



INDEX OF DRUGS. 



695 



RASPBERRY, 311 
Rectal medication. 20 
Rectified spirit, 53 
Red cinchona, 148 

iodide of mercury, 252 

oxide of mercury, 257 

precipitate, 257 
ointment, 257 

rose, 311 

saunders, 319 

wine, 53 
Reduced iron, 228 

Remedial Measures other than Drugs, 359 
Remedy, cold, as a, 366 
Resin, 308 

ointment, 308 

plaster, 237, 308 
Resina, 308 

jalapte, 230 

podophylli, 305 

scammonii, 322 
Resorcin, 308 
Rest cure, 394 
Revulsives, 32 
Rhatany, 232 
Rheum, 309 

radix, 309 
Rhigolene, 309 
Rhubarb, 309 
Rhus aroma tica 310 

glabra, 310 
Rice-water, 410 
Roborants, 32 
Rochelle salt, 311 
Rosa centifolia, 311 

gallica, 311 
Rose-water, 311 
Rosin, 308 
Rottlera, 231 
Rubus idreus, 311 
Rue, 311 

Rules for dosage, 24 
Rum, 53 
Russian bath, 389 



OABIXA, 322 

kJ Saccharated carbonate of iron, 225 

iodide of iron, 227 

pepsin, 290 

solution of lime, 108 
Saccharin, 312 
Saccharum, 335 

lactis, 336 

officinarum, 335 

purificatum, 333 
Sal prunella, 263 
Salicylate of bismuth, 312 

of lithium, 239 

of mercury, 312 

of methyl, 192 

of physostigmine, 299 

of sodium, 317 
Salicylic acid, 313 

ointment, 317 
Salol, 317 
Salophen, 313 
Salt, 134 
Saltpetre, 263 
Salts, 242 
Sandalwood, 319 
Sanmrinaria, 319 



Santalum rubrum, 319 
Santonin, 320 

Santoninate of sodium, 320 
Santoninic acid, 320 
Santoninum, 320 
Sapo, 326 

duris, 326 

mollis, 327 
Sarsse radix, 321 
Sarsaparilla, 321 
Savinge cacumina, 321 
Savine, 322 

ointment, 322 
Scammonium, 322 
Scammony, 322 
Scilla, 332 
Scillin, 332 
Scillipikrin, 332 
Scillitoxin, 332 
Sclerotinic acid, 179 
Scopari cacumina, 323 
Scoparius, 323 
Seidlitz powder, 324 
Senega, 324 
Senega? radix, 324 
Senna, 325 

Alexandrina, 325 

Indica, 325 
Serpentaria, 326 

rhizoma, 326 
Sherry, 53 
Silicate of potassium, 326 

of sodium, 326 
Sinapis alba, 261 

albse semina, 261 

nigra, 261 

nigrse semina, 261 
Sinapisma, 261 
Slaked lime, 108 
Smooth sumach, 310 
Snake-weed, 189 
Soap, 326 

liniment, 110, 327 

plaster, 327 
Socotrine aloes, 55 
Soda, 127 

caustica, 127 

tartarata, 311 
Sodii acetas, 328 

arsenas, 80 

bicarbonas, 90 

boras, 93 

bromidum, 99 

chloridum, 134 

hyposulphis, 329 

iodidum, 214 

nitris, 400 

phosphas, 294 

et potassii tartras, 31 1 

salicylas, 317 

santoninas, 320 

sulphas, 329 
Sodio-theobromine-salicylate, 327 
Sodium, 328 

chloride, 134 

ethylate, 328 

hyposulphite, 329 

sulphate, 329 
Soft petrolatum, 291 
Solanum carolineuse, 329 
Soluble glass, 326 
Solution of acetate of ammonium, 61 



696 



INDEX OF DRUGS. 



Solution of acetate of iron, 229 
of morphine, 283 

of ammonia, 61 

of arsenate of potassium, 80 
of sodium, 80 

of arsenous acid, 80 

of carbonate of magnesium, 242 

of chloride of antimony, 70 
of zinc, 134 

of chlorinated lime, 135 

of chromic acid, 147 

of citrate of ammonium, 63 

of bismuth and ammonium, 90 

of iron, 226 

of potassium, 155 

of hydrochlorate of morphine, 283 

of iodide of arsenic and mercury, 80 

of iodine, 518 

of lime, 108 

of nitrate of mercury, 256 

of pepsin, 290 

of perchloride of mercury, 252 

of permanganate of» potassium, 291 

of persulphate of iron, 228 

of potassa, 239 

of soda, 127 

of subacetate of lead, 236 

of sulphate of atropine, 88 
of morphine, 283 
Somnal, 330 
Sova bean, 330 
Sozoiodol, 330 
Spanish fly, 114 
Sparteine, 323 
Spice plaster, 378 
Spigelia, 331 
Spirit of Mindererus, 61 

of turpentine, 350 
spray, 22 
Spiritus setheris compositus, 201 
nitrosi, 342 

ammonite, 61 

aromaticus, 61 
fcetidus, 61 

cajuputi, 104 

camphorse, 110 

chloroformi, 145 

cinnamomi, 154 

frumenti, 53 

gaultherise, 193 

glonoini, 269 

juniperi, 53, 231 

compositus, 53, 231 

menthpe piperita?, 289 

myristicae, 272 

odoratus, 53 

phosphori, 297 

rectificatus, 53 

tenuior, 53 

vini gallici, 53 
Springs, mineral, 396 
Squill, 332 

Squirting cucumber, 178 
Starch, 333 
Stillingia, 333 
Stramonii folia, 334 

semen, 334 
Stramonium, 334 
Strength, relative, of drugs, 27 
Stronger water of ammonia, 60 
Strophanthin, 335 
Strophanthus, 335 



Strontium, 334 

bromide, 334 

iodide, 334 

lactate, 334 

phosphate, 334 
Strychnine sulphas, 275 
Strychnine, 272 
Styptic collodion, 164 
Subcarbonate of bismuth, 91 
Subgaliate of bismutb, 92 
Sublimed sulphur, 339 
Subnitrate of bismuth, 91 
Subsulphate of iron, 228 
Succinum, 58 
Succus belladonna?, 88 

conii, 167 

hyoscyami, 209 

limonis, 156 

scoparii, 324 

taraxaci, 345 
Sugar. 335 

of lead, 235 

of milk, 336 
Sulphate of aluminum, see Abua. 57 

of ammonium. <ii 

of atropine, 84-88 

of cincbonidine, 153 

of cinchonine, 153 

of copper, 169 

of hyoscyamus, 309 

of iron. 229 

and ammonium, 224 

of magnesium. 242 

of manganese. 243 

of morphine. 283 

of physostigmine, 299 

of quinidine. 153 

of sodium, 329 

of sparteine, 323 

of strychnine, 275 

of zinc, 336 
Sulphide of ammonium, 164 

of antimony. 66 

of calcium, 337 
Sulphides, 335 
Sulphocarbolate, 337 

of soda, 337 

of zinc, 365 
Sulphonal, 337 
Sulphur, 339 

lot urn, 339 

ointment, 340 

praecipitatum, 339 

sublimatum. 339 
Sulphurated antimony 66 

lime, 108 
Sulphuric acid, 340 
Sumach, smooth, 310 

sweet, 310 
Sumbul, 341 

pill, 342 

radix, 341 
Suppositoria acidi carbolici cum sapoue. 121 
tannici. 344 

glycerina, 196 

hydrargyri, 256 

iodoformi, 221 

morphinae, 283 > 

cum sapone, 283 

plumbi composita, 236 
Suppositories, 23 
Suspension. 401 
Swamp hellebore, 354 



INDEX OF DRUGS. 



697 



Sweet almonds, 54 

spirit of nitre, 342 
sumach, 310 
Sydenham's laudanum, 282 
Syrup of tar, 304 
Syrup us acacias, 39 
acidi citrici, 156 

hydriodici, 219 
allii, 54 
amygdalae, 54 
calci lactophosphatis, 106 
chloral, 131 
ferri brornidi. 225 

iodidi, 227 

phosphatis, 228 

quininae et strychninae phospha- 
tum, 228 
hypophosphitum, 106 

cum ferro, 227 
ipecacuanhas, 223 
kranieriae, 232 
limonis, 156 
picis liquidae, 304 
pruni Virginianee, 307 
rhei, 310 

aromaticus, 310 
rosae, 311 
rubi idaei, 311 

sarsaparillae compositus, 321 
scillae, 332 

compositus, 332 
senegse, 324 
sennae, 325 
zingiberis, 195 



TABACUM. 348 
folia, 348 
Tabellse nitroglycerin!, 269 

Tablets, 23 

of nitroglycerin, 269 
Taeniin, 173 
Tamarinds, 343 
Tamarindus, 343 
Tanacetum, 344 
Tannate of quinine, 153 
Tannic acid, 343 
Tansy, 344 

tea, 344 
Tar, 304 

ointment, 304 
Tar-water, 304 
Taraxacum, 345 
Tartar emetic, 66 
Tartaric acid, 345 
Tartrate of antimony and potassium, 66 

of iron and ammonium, 226 
and potassium, 226 

of potassium and sodium, 311 
Terebene, 344 
Terebinthina, 350 
Terpiu hydrate, 346 
Terpinol, 346 
Tetronal. 349 
Tbapsia, 346 
Tbebaine, 276 
Theine. 102 
Theobromine, 327 
Therapeutic considerations, 17 

nihilism, 17 
Therapeutics, definition of, 18 
Thiol, 347 



Thiolum liquidum, 347 

sicca, 347 
Thiosulphite of sodium, 329 
Thoroughwort, 189 
Thymol, 347 

iodide, 348 
Tinctura aconiti, 47 
aloes, 56 

et myrrhae, 56, 262 
arnicee, 77 

florum, 77 

radix, 77 
asafoetidae, 82 
belladonnas foliorum, 88 
benzoini, 90 

composita, 90 
bryoniae, 101 
buchu, 102 
calumbae, 107 

camphorae composita, 110, 281 
cannabis indicee, 114 
cantharidis, 115 
capsici, 117 
cardamomi, 123 

composita, 123 
catechu, 127 

composita, 127 
chiratae, 128 
chloroformi composita, 146 

et morphinae, 146, 283 
cimicifugae, 148 
cinchonae, 153 

composita, 153 
cinuamomi, 154 
colchici seminis, 164 
columbae, 106 
conii, 167 
convallaria, 167 
cubebae, 173 
digitalis, 178 
ergotae, 171 
ferri chloridi, 225 

perchloridi, 226 
fortior, 226 
gallae, 192 
gelsemii, 194 
gentianae composita, 194 
guaiaci, 198 

ammoniata, 198 
hamamelidis, 201 
humuli, 203 
hydra stis, 205 
hyoscyami, 209 
iodi, 218 

colorless, 218 
ipecacuanhae et opii, 282 
jaborandi, 302 
jalapae, 230 
kino, 232 
krameriae, 232 
lobelia?, 241 

etberea, 241 
lupuli, 204 
moschi, 261 
myrrhae, 262 
nucis vomicae, 275 
opii, 282 

ammoniata, 282 

camphorata, 281 

deodorati, 282 
physostigmatis, 299 
podophylli, 305 



698 



INDEX OF DRUGS. 



Tinctura quassias, 308 

quininas armnoniata, 154 

rhei, 310 

aromatica, 310 
dulcis, 310 

sabinas, 322 

sanguinarise, 320 

saponis mollis, 326 

scillae, 332 

senegas, 324 

sennas, 325 

serpentarias, 326 

stramonii seminis, 334 

strophanthi, 335 

sumbul, 342 

valeriana3, 353 

ammoniata, 353 

veratri viridis, 356 

zingiberis, 195 
fortior, 195 
Tinctures, 23 
Tobacco, 348 
Tonics, 32-38 
Touchwood, 48 
Transfusion, 402 
Tribromethane, 100 
Trichloracetic acid, 349 
Trikresol, 349 
Trional, 349 
Triturates, 24 
Trituratio elaterini, 179 
Troches, 24 

Trochisci acidi-benzoici, 90 
-tannici, 344 

bismuthi, 91 

catechu, 127 

cretas, 107 

cubebas, 173 

ferri redacti, 225 

glycyrrhizas et opii, 239 

ipecacuanhas, 223 

kramerias, 232 

magnesias, 241 

menthas piperita?, 289 

morphinas, 283 

et ipecacuanhas, 223, 283 

opii, 282 

potassii chloratis, 134 

santonini, 321 

sodii santoninatis, 321 

zingiberis, 195 
Tully's powder, 283 
Turkish bath, 387 ■ 

home modification of, 389 
Turpentine, 350 

liniment, 352 

ointment, 352 

stupe, 378 
Turpeth mineral, 257 

UNGUENTUM acidi carbolici, 120 
gallici, 192 

salicylici, 317 

tannici, 344 
aconitinas, 47 
antimonii tartarati, 69 
aquae rosas, 311 
atropinas, 89 
belladonna, 89 
cantharidis, 115 
cetacei, 89 
chrysarobini, 147 



Unguentum creosoti, 171 
eucalypti, 189 
gallas, 192 

cum opio, 192 
hydrargyri, 255 

ammoniati, 250 

iodidi rubri, 252 

nitratis, 257 

dilutum, 257 

oxidi flavi, 257 
rubri, 257 
iodi,219 

iodoformi, 219, 221 
mezerei, 260 

subchloridi, 254 
petrolei, 291 
picis liquidas, 304 
plumbi acetatis, 236 

carbonatis, 236 

iodidi, 236 
potassii iodidi, 214 
resinas, 308 
sabinse, 322 
stramonii, 334 
sulphuris, 340 
terebinthinas, 352 
veratrinas. 354 
zinci oxidi, 284 
Ursin, 352 
Uva ursi, 352 
Uvas ursi folia, 352 



VALERIAN, 352 
Valeriana rhizoma, 352 
Valerianate of ammonium, 64 

of iron, 229 

of quinine, 153 

of zinc, 353 
Valerianic acid, 353 
Vallet's mass, 225 
Vapor acidi hydrocyanic!, 207 

chlori, 135 
•conii, 167 

creosoti, 171 

iodi, 218 
Vaseline, 291 
Vasomotor depressants, 32-38 

stimulants, 32-38 
Venesection, 404 
Veratri viridis rhizoma, 354 
Veratrina, 353 
Veratrine ointment, 354 
Veratroidine, 355 
Veratrum viride, 354 
Vienna paste, 356 
Vinegar, 44 

of lobelia, 241 

of opium, 282 

of sanguinaria, 320 

of squill, 223,332 
Vinegars, 22 
Vinum album, 53 

aloes, 56 

antimoniale, 69 

antimonii, 69 

colchici, 164 
radicis, 164 
seminis, 164 

ergotas, 181 

ferri, 229 

amarum, 229 



INDEX OF DRUGS. 



699 



Vinum ferri citratis, 229 

ipecacuanha, 223 

opii, 282 

picis, 304 

portense, 53 

quininse, 154 

rhei, 310 

rubrum, 53 

tabaci, 349 

xericuni, 53 
Virginia snake-root, 326 



WAHOO, 189 
Warburg's tincture, 356 
Warming plaster, 115 
Wash, black, 252 

yellow, 257 
Washed sulphur, 339 
Water of chloroform, 145 
Watered toast, 412 
Wet pack, 387 
Whiskey, 53 
White ginger, 194 

lead, 236 

mustard, 261 

oak, 308 

precipitate, 250 
ointment, 250 

wine, 53 
Whvtt's tincture, 153 
Wild cherry, 306 
Wine, 53 

of aloes, 56 

of antimony, 69 

of citrate of irou, 229 

of colchicum-root, 164 

of colchicum-seed, 164 

of ergot, 181 

of iron, 229 



Wine of iron, bitter,. 229 
of ipecac, 223 
of opium, 282 
of rhubarb, 310 
of tar, 304 
of tobacco, 349 
whey, 411 

Wines, 24 

Wintergreen, 192 

Witch-hazel, 200 

Wood oil, 200 

Wormseed, 128 



VANTHOPUCCINE, 204 



YELLOW CINCHONA, 148 
gentian, 194 
iodide of mercury, 257 
jessamine, 193 
oxide of mercury, 257 
sulphate of mercury, 257 
wash, 257 
Young's rule for dosage, 24 



ZINC, 357 
Zinci acetas, 44 
carbonas, 122 

prsecipitatus, 122 
chloridum, 134 
oxidum, 284 

venale, 284 
phosphidum, 295 
sulphas, 335 
valerianas, 353 
Zingiber, 195 



INDEX OF DISEASES AND REMEDIES. 



ABORTION, 413 

Cascara sagrada, or compound liquorice 
powder, as a laxative ; if these fail, rhu- 
barb or castor oil, 413 

Cimicifuga, fluid extract, gtt. 10 to 20 (0.65- 
1.3), night and morning, as a prophylac- 
tic, 414 

Creolin (2 per cent, solution), should be in- 
jected after removal of the membranes, 
or if fever should follow, 415 

Curettement, 415 

Diet and hygiene, 413 

Elaterium, jalap, scammony, strychnine, 
erigeron, cantharides, contraindicated, 
unless very necessary, 413 

Ergot and quinine, in small doses, with 
perfect rest for one or two weeks, and 
antiseptic irrigation as an after-treat- 
ment, 414 

Iodine, applied to the inner surface of 
uterus, after removal of membranes, as 
a hemostatic and antiseptic, 415 

Opium or morphine, best agents to quiet 
uterus if abortion threatens, 414 

Podophyllin, senna, salines in active doses, 
and aloes, not to be used if they can be 
avoided, 413 

Quinine, useful in malarial poisoning, as a 
preventive; in other cases contraindi- 
cated, 414 

Saline purges contraindicated, except in 
plethoric women, 413 

Sponges should not be used as tampons, 414 

Tampons of absorbent cotton, dusted with 
iodoform, followed later by ergot, if 
abortion is inevitable, 414 

Venesection useful in plethoric women to 
prevent, 414 

Viburnum prunifolium, fluid extract, 
drachm 1 to l£ (4.0-6.0), taken during 
pregnancy as a prophylactic, 414 

ABSCESS, 415 

Aconite or veratrum viride, in full dose, 
often aborts, 415 

Alcohol, given with milk, in cold abscess, 
416 

Belladonna ointment, locally applied, to 
abort ; or tincture, internally, if aco- 
nite is not at hand, 415 

Calx sulphurata, gr. T V (0.006) every hour 
or two, useful to abort or cause absorp- 
tion, 415 

Carbolic acid, minims 5 to 10 (0.3-0.65) of 
2 per cent, solution, injected into gland 
threatening suppuration, 415 



Cod-liver oil with hypophosphites, quinine, 
and iron useful in cold abscess, 416 

Hydrogen peroxide, 10 per cent, solution, 
to wash out cavity of tubercular or slow 
abscess, 416 

Incision, if pus forms, followed by irriga- 
tion with carbolic acid (1 : 20) or bi- 
chloride solution (1 : 5000) and anti- 
septic dressing, 416 

Iodine, locally applied, may abort, 415 

Iodoform gauze, packed into cavity, or 
ethereal solution injected after aspira- 
tion, aud antiseptic dressing, useful in 
tubercular abscess, 416 

Lead-water, applied on bread-crumb poul- 
tice or lint, in early stage, to abort, 415 

Nitrate of silver, gr. 20 to 40 (1.3-3.0) to 
the ounce, locally applied, may abort, 
415 

Poultices to assist maturation, 416 

Prescriptions for tonics, in cold abscess, 416 

ACIDITY. 

Ammonia, the most active remedy in gas- 
tric acidity, contraindicated if acute 
irritation exists, 60 

Bicarbonate of sodium, in form of effer- 
vescing powder, valuable in gastric acid- 
ity, 90 

Carbonate of calcium, precipitated, best 
antacid in intestinal acidity, 105 

Cerium oxalate, used in some cases of gas- 
tric acidity instead of bismuth, 128 

Charcoal useful in some cases of "sour 
stomach," 121 

Lime-water, 108 

ACNE, 417 

Calx sulphurata, gr. ^ to J (0.006-0.008) in 
pill, thrice daily, in pustular acne, 417 

Carbolic acid touched to pustules, after in- 
cision, 417 

Cod-liver oil, if scrofulosis exists, 417 

Fowler's solution often cures and prevents 
relapse, dose gtt. 1 to 3 (0.05-0.15) thrice 
daily for a month or two, 417 

Green or Castile soap used, in face-bath 
night and morning, followed by brisk 
rubbing ; if irritation ensues, simple 
cerate or emulsion of bitter almonds 
will relieve, 417 

Ichthyol, 20 parts to 100 of lard well rubbed 
in, when induration is great, 417 

Mercurial ointment, to relieve induration, 
several days intervening between its 
use and that of sulphur, 417 

701 



702 



INDEX OF DISEASES AND REMEDIES. 



Phosphorus, especially useful in acne indu- 
rata, 297 

Eesorcin, gr. 10 to 20 to the ounce (0.65- 
1.3 : 32.0) of lard, when induration is 
great, 417 

Saline purges, followed by cascara sagrada 
or similar remedy, to regulate bowels, 
if dependent upon obstinate constipa- 
tion, 417 

Sulphur internally and as a wash or oint- 
ment for women with disordered men- 
struation, prescription for, 417 

ADENITIS, 418 

Ichthyol, prescription for, 418 

Iodine ointment and lard, equal parts, ap- 
plied by inunction night and morning, 
or tincture, as a paint, stopping applica- 
tion on appearance of redness or fluc- 
tuation, 418 

Iron, syrup of the iodide, gtt. 5 to 20 (0.3- 
1.35) in children, 418 

Lancing preferable to allowing abscess to 
break, 418 

Poultice, when redness or fluctuation ap- 
pears, 418 

Removal of gland by dissection, if enlarge- 
ment is scrofulous, 418 

Tonics, to improve systemic condition, 418 

ALBUMINURIA. (See Bright's Diease.) 
Gallic acid, if due to atony of kidneys, 192 
Strontium lactate, 334 

ALCOHOLISM. (See Poisoning from 
Alcohol.) 

ALOPECIA, 418 

Chrysarobin, drachm h to 1 (2.0-4.0) to lan- 
olin 1 ounce (32.0), 418 

Corrosive sublimate, gr. 2 to 5 (0.1-0.3) to 
rectified spirit 1 drachm (4.0) and oil of 
turpentine 7 drachms (28.0), 419 

Liquor epispasticus painted over bald spot 
after loose hairs have been depilated, 
418 

Pilocarpine, locally applied, often stimu- 
lates new growth ; too much causes 
small pustules around follicles ; pre- 
scription for, 301 

AMBLYOPIA AND AMAUROSIS, 419 

Autipyrine, 420 

Bromide of potassium, 420 

Cauterization of nape of neck, 419 

Correction of optical errors, when arising 
from congenital trouble or non-use, 419 

Cups, wet and dry, 419 

Digitalis in toxic cases, 420 

Electricity, constant current, 420 

Emmenagogues, if due to menstrual dis- 
orders, 419 

Fly-blister to temple in some cases, 420 

Iodide of potassium, 420 

Mercury, when due to syphilis, 420 

Metallo-therapy, may be tried in hysterical 
cases, 419 

Nitrite of amyl, inhalations, 420 

Nitro-glycerin, 420 

Nux vomica in ascending doses in tobacco 
or alcoholic cases, 274 

Pilocarpine, in uraemic, tobacco, or alcohol 
amaurosis, 301, 420 



Salicylates, 420 

Strychnine, hypodermically, after irritation 

has subsided, 420 
Suspension, and injections of testicular 

juice, 420 

AMENORRHEA, 420 

Aloes, as a specific, when dependent upon 
constipation, atony of sexual system, or 
anaemia, 56, 421 

Apiol, 3 to 10 minims (0.15-0.65) in capsule 
thrice daily for a week before date of 
menstruation, 75, 421 

Arnica, 76 

Bin oxide of manganese, gr. 1 to 3 (0.05- 
0.15), taken for two weeks before time 
of menstruation, 421 

Cantharides, as a stimulant, if due to atony 
or depression, 114 

Cimicifuga, fluid extract, gtt. 30 (2.0), at 
the proper time for a flow, 421 

Dewees's emmenagogue mixture, 421 

Eupatorium, in hot infusion, if due to cold, 
189 

Goodell's prescription for, 421 

Griffith's pills, largely used when depend- 
ent upon anaemia, 225 

Hot sitz-bath, for several nights before 
period ; mustard added often increases 
its efficacy, 421 

Iron and myrrh, a standard remedy if due 
to atony or anaemia, 421, 262 

Oil of rue, gtt. 5 (0.3), in capsule, thrice 
daily, 421 

Potassium permanganate, useful, but infe- 
rior to binoxide of manganese, 421 

Salines inferior to aloes if due to constipa- 
tion, 421 

Savine, gtt. 5 (0.3), in capsule, thrice daily, 
to stimulate uterus, 421 

Tansy, gtt. 5 (0.3), in capsule, thrice daily, 
or in form of tansy tea, 421 

ANEMIA, 421 

Arsenic, not to exceed gr. ^ (0.004) daily, 
alone or combined with iron, valuable, 
425 ; very valuable in pernicious anae- 
mia, 78 

Arsenite of copper, 425 

Bitters, simple or aromatic, in conjunction 
with iron, when stomach and intestines 
are atonic, 424 

Blaud's pill, 424 

Bromide of iron, gr. 5 to 20 (0.3-1.3), in 
syrup, useful when there is chorea, 225 

Bullock's blood, fresh or dried, given by 
enema when iron fails, 425 

Chloride of iron, useful because of its tonic 
properties, 226 

Diet and hygiene, 425 

Hypophosphites and phosphate of lime, 
with cod-liver oil, iron, and quinine, 
when anaemia is due to childbearing 
and lactation, 424 

Intravenous injections, 392 

Iodide of iron, syrup of, largely used in 
strumous and scrofulous anaemias, 227 

Mercury bichloride, or calomel, especially 
valuable in syphilitic cases. Inunctions 
of mercurial ointment, once a day or 
every other day, of service in all forms 
of anaemia, 424, 425 



INDEX OF DISEASES AND REMEDIES. 



703 



Quinine in malarial cases, and in tonic 
doses in all other anaemias, 424 

Reduced iron, with laxatives and mineral 
acids for their effects on intestines and 
liver, in uncomplicated cases, 424 

Sulphate of iron or some other astringent 
preparation in conjunction with mild 
purges, when tongue is broad, flabby, 
and white, 424 

ANAL FISSURE, 425 

Carbolic acid, 1 drop (0.05), applied to fis- 
sure to effect cure, in addition when 
hemorrhoids are present a lotion of 
tannic acid, glycerin, and water, 426 

Castor oil, to relieve bowels if sulphur can- 
not be used, 426 

Flexible collodion painted over spot, may 
relieve, 426 

Iodoform suppositories, gr. 2 to 10 (0.1-0.65), 
relieve pain of defecation ; belladonna, 
gr. i (0.016) to be added when there is 
spasm of sphincter, 426 

Potassium bromide, drachms lh to the ounce 
(6.0 : 32.0) of glycerin, locally applied by 
means of a brush to fissure, highly rec- 
ommended, 426 

Sulphur, 20 to 40 grains (1.3-2.6), combined 
with powdered cinnamon or aromatic 
powder, at night to render passages soft, 
426 

ANEURISM, 426 

Aconite, inferior to veratrum viride as a 
cardiac sedative, 426 

Chloroform inhalation if dyspnoea is great, 
427 

Digitalis, contraindicated, 426 

Iodide of potassium, in large doses, asso- 
ciated with restricted diet and rest in 
bed ; more valuable in syphilitic than 
in other forms of the disease, 213, 426 

Morphine, gr. J (0.008), combined with 
croton chloral, gr. 10 (0.65), in sleepless- 
ness due to pain, 427 

Veratrum viride, gtt. 1 to 2 (0.05-01), twice 
or thrice daily if heart is excitable and 
vascular tension high, 426 

ANGINA PECTORIS, 427 

Alcohol, instead of nitrites, when there is 

vascular relaxation, 427 
Antipyrine, gr. 20 (1.3), valuable in some 

cases, 427 
Arsenic, in full dose long continued, and 

elimination of causes of nerve-storm, 428 
Cocaine, highly recommended, 428 
Cactus grand i floras, in some cases, 103 
Digitalis, when heart is weak, 427 
Ether, in 1-drachm (4.0) doses in ice-water 

or capsule, to nervous females, often 

aborts, 427 
Hoffmann's anodyne, often the best rem- 
' edv, 427 
Morphine, gr. i to i (0.016-0.03) hypoder- 

mically, when nitrite of amyl fails to 

relieve, 428 
Nitrite of amyl, inhalation of a few drops 

from handkerchief during attack, 427 
Nitrite of sodium or potassium, gr. 3 (0.15), 

thrice daily, useless unless arterial ten- 
sion is high and heart throbbing, 427 



Mtro-glycerin, gtt. 1 (0.05) of a 1 per cent, 
solution during attack, 427 

Phosphorus, gr. 1-100 (0.0006), after meals, 
often of value, 428 

Stomach-pump may be required when due 
to overloaded stomach, 428 

Tonics combined with careful diet and hy- 
giene necessary to a cure, 428 

ANOREXIA, 428 

Calomel, useful when following acute dis- 
ease ; nitro-muriatic acid, however, gen- 
erally preferable, 254 

Capsicum, in convalescence, acts most fav- 
orably, 116 

Chimaphila, in dropsical patients, as a 
tonic and diuretic, 128 

Gentian, 194 

Prescriptions for tonics, 428 

Quassia, especially valuable when following 
malarial fever, 307 

APOPLEXY, 429 

Belladonna, hypodermically, if respiration 
fail, 430 

Croton oil, gtt. 1 (0.05) with sweet oil gtt. 5 
(0.3), as a depletant cathartic, 429 

Elaterium, gr. J (0.01), as a depletant 
cathartic, 429 

Iodide of potassium, in large doses several 
days after attack, when clot has firmly 
formed, to promote absorption, 429 

Massage and electricity, applied to muscles 
to prevent atrophy ; contraindicated if 
inflammation exist, 429 

Mercury, 429 

Mustard plaster to feet, or mustard foot- 
bath and ice to head, keeping head high 
and feet low, 429 

Opium and calomel, gr. I (0.016) of each 
every four hours, if meningitis arise, 
429 

Stimulants contraindicated, 430 

Strychnine, hypodermically, if respiration 
fail ; also useful to stimulate trophic 
centres in cord, 430 

Venesection, if patient is full-blooded, to 
prevent inflammation and further leak- 
age, 429 

Veratrum viride or aconite, when venesec- 
tion is impossible, to lower blood-pres- 
sure, 429 

APPENDICITIS. 

Absolute rest necessary, 430 

Ice-bag or leeches, applied to appendicular 

region, 430 
Magnesium sulphate or citrate, 431 
Opium or morphine (after the bowels have 

moved), to relieve pain and act as an 

antiphlogistic, 431 
Surgical treatment, 431 

ARTHRITIS. 

Bicarbonate of sodium, applied to part on 
lint to allay pain, 90 

Lithium, carbonate and citrate, prevent 
deposit in joints from rheumatoid ar- 
thritis, 239 

Mustard plaster, as a counter-irritant, 261 

Veratrine ointment, 354 



704 



INDEX OF DISEASES AND REMEDIES. 



ASCARIS LUMBRICOIDES. (See Worms.) 
ASCITES. (See Dropsy.) 

ASPHYXIA, 430 

Ammonia, intravenously injected into leg, 
to stimulate heart and respiration, 431 

Artificial respiration, Sylvester's method, 
431 

Electricity, only to be used as a peripheral 
irritant to restore respiration, 430 

Oxygen inhalations, 285 

Eules regarding position of patient, 432 

ASTHENOPIA, 432 
Cannabis indica, in retinal asthenopia, 

113 
Eserine or pilocarpine, weak solution, as a 

stimulant to ciliary muscles, 432 
Glasses, combined with prisms if necessary, 

to correct optical defects, 433 
Massage, rest, salt baths, strychnine, and 

iron, if due to neurasthenia, 433 
Strychuine or tincture of mix vomica in 

large doses, to stimulate ciliary muscles, 

432 

ASTHMA, 433 

Aconite, in early stages, 47 

Arsenic, internally or smoked in cigarettes, 
best remedy when mucous membrane is 
at fault, 79, 436 

Belladonna, combined with morphine, very 
useful, 86, 434 

Bromide of potassium or sodium, gr. 30 
(2.0), half an hour before retiring, 436 

Bronchitis-tent, 436 

Chloral, rarely useful ; if pushed, danger- 
ous, 131 

Chloroform, inhaled, relaxes spasm ; also 
useful in form of liniment applied to 
breast, to abort, 146 

Cocaine, applied to nasal cavities, if due to 
nasal disorders, 435 

Coffee, a cup of strong black, during parox- 
ysm, 104 

Compressed and rarefied air, 436 

Diet and hygiene, 436 

Ethyl iodide, to increase secretions and 
prevent thickening, 188 

Euphorbia pilulifera, % to 1 drachm (2.0-4.0) 
of the fluid extract, 188, 435 

Gelsemium, 193 

Grindelia, fluid extraet of, gtt. 20 to 60 
(1.3-4.0), or leaves soaked in nitre 
smoked as cigarettes, or fumes of burn- 
ing leaves inhaled, exceedingly useful, 
198, 436 

Iodide of potassium, useful in bronchial, 
harmful in gastric type, 436 

Lobelia, tincture, gtt. 10 (0.65) every four 
hours, if attack threaten ; in emetic 
dose if heart be strong, when spasm is 
present, 435 

Morphine, hypodermically, gr. h to I (0.010- 
0.016), alone or combined with atropine, 
434 

Nitrate of potassium alone or combined 
with belladonna, in form of cigarettes 
or inhalations of fumes, often relieves, 
435 

Nitrite of amyl, 3 to 6 drops (0.15-0.3) on 



handkerchief, inhaled with care, relieves 
spasm, 435 

Nitro-glycerin, serviceable if bronchial mu- 
cous membranes are engorged, 269 

Oil of amber, 58 

Oxygen, inhalations when cyanosis is ex- 
treme, 436 

Physostigma, in bronchial asthma, to aid in 
expelling mucus, 298 

Sandalwood oil, useful in catarrhal cases, 
319 

Tobacco-smoking often efficacious to pa- 
tients not accustomed to it, 435 

ATONY. 

Arsenic, in gastric and intestinal atony, 78 

Calumba, valuable in gastro-intestinal 
atony following fevers, 108 

Capsicum, one of the best remedies in gas- 
tric atony due to debility and alcohol- 
ism, 116 

Cardamom, with bitter tonics and mineral 
acid in gastro-intestinal atony. 123 

Chimaphila, useful as a stimulating diu- 
retic in atonic renal conditions, 128 

Hydrastis, indicated in atony of mucous 
membranes, 204 

Leptandra, in duodenal atony, 238 

Lime salts, useful in atony of mucous mem- 
branes, 108 

Pepper, in atony of genito-urinary mucous 
membranes, 288 

Physostigma, in intestinal and vesical 
atony, 298 

Strychnine, in intestinal atony, 278 

BALANITIS AND BALANO-POSTHITIS, 

532 

Astringent solutions, to cleanse parts, zinc 
chloride, (gr. 4 to the ounce [0.2 : 32.0]), 
boric acid (1 per cent.), carbolic acid 
(1.5 per cent.) ; silver nitrate (gr. 1 to 
the ounce [0.05 : 32.0] ) especially valu- 
able, 532 

Lead-water, dilute, as a wet dressing, pre- 
ceded by astringent washes, in phimosis ; 
if inflammation increase, circumcise, 
533 

Silver-nitrate stick, touched to ulcerations, 
532 

Tannin or zinc oxide, as a dusting powder, 
after retracting prepuce and cleansing 
parts, followed by returning prepuce 
over absorbent cotton, 533 

BALDNESS. (See Alopecia.) 

BED-SORES, 436 

Aloes, glycerole of, as a local application, 

56 
Alum, with spirit of camphor and white 

of egg, locally applied, to prevent, 437 
Catechu, with lead acetate, locally applied, 

to harden skin, 436 
Glycerin, application daily, after washing 

and rubbing part, to prevent, 197 
Incision, followed by irrigation, if sores 

tend to burrow, 437 
Iron, tincture of chloride, gtt. 20 (1.3) every 

four hours as a tonic, 437 
Salt and whiskev, rubbed over skiu to 



INDEX OF DISEASES AND REMEDIES. 



705 



harden it (drachms 2 to the pint [8.0 : 

500 cc.]), 436 
Nitrate of silver (gr. 20 to the ounce [1.3 : 

32.0]), painted over threatening part, to 

abort. If ulcers form and are sluggish, 

same solution may be used, 437 
Soap plaster, applied to sore after washing 

with bichloride solution (1 to 5000) and 

dusting with iodoform, 437 
Supportive measures and increased amount 

of food, if sloughs are large, 437 
Zinc ointment, on squares of lint, sometimes 

used in lieu of soap plaster, 437 

BILIOUSNESS, 437 

Aconite, antagonizes the poisonous alka- 
loids which cause slow pulse, high arte- 
rial tension, etc., 440 

Ammonium chloride, grs. 5 (0.3) thrice 
daily, if associated with catarrh, 440 

Bromides and chloral if nervousness and 
irritation are present, 440 

Calomel, gr. £ (0.01) in powder every fifteen 
minutes until six are taken, followed in 
four hours by a saline, if stools be light, 
439 

Chirata, extract of, gr. 5 (0.3), in hepatic 
torpor, 440 

Diet, 439 

Euonvmus, extract of, dose 3 gr. (0.15), 
440 

Horseback riding combined with gym- 
nastic movements especially valuable, 
439 

Ipecac, powdered, gr. 30 to 60 (2.0-4.0) or 
apomorphine, gr. T ^ (0.004) hypoder- 
mically, may relieve in first stage, 439 

Leptandra, where liver is torpid, 238 

Mustard plaster or cup to nape of neck, if 
face is flushed, foot-bath also of service, 
440 

Nitro-muriatic acid, gtt. 3 (0.15), thrice 
daily in water, of great service, 440 

Opium, antagonizes the poisonous alkaloid 
which causes hot skin, rapid pulse, di- 
lated pupils, etc., 440 

Podophyllin, gr. \ (0.01), if stools be dark, 
439 

Protiodide of mercury, gr. -fa to fa (0.001- 
0.0016), in trituration, thrice daily, if 
due to catarrh, 440 

Salines, if attack is sudden, to sweep out 
poisonous matter, 439 

Salol or salophen, in 10- gr. (0.65) doses, 
useful as an intestinal antiseptic, 440 

Stillingia, fluid extract of, dose 20 drops 
(1.3), 440 

BLEPHARITIS, 439 

Boric-acid lotion when there is accompany- 
ing conjunctivitis, 441 

Chloral, 5 per cent, solution, to remove 
scabs and crusts, 441 

Creolin, 1 to 2 per cent, solution, useful as 
a wash, 172 

Ointments, dilute citrine, Pagenstecher's 
(yellow oxide of mercury, 1 gr. [0.05] ; 
vaseline, 1 drachm [4.6]), pyrogallic 
acid, milk of sulphur (3 per cent.), lo- 
cally applied after removal of crusts, 
441 

45 



Silver nitrate, touched to crater-like ab- 
scesses, gives good results, 441 

Sodium bicarbonate or biborate, solution 
gr. 8 to ounce (0.5 : 32.0), to remove 
scabs and crusts, 441 

BOILS, 441 

Belladonna, locally applied to relieve pain 
and inflammation, 441 

Calcium sulphurata hastens pointing and 
prevents formation of new ones ; use- 
less in boils of diabetes, 98, 441 

Camphorated alcohol, applied over boils in 
formative stage, then wiped dry, fol- 
lowed by camphorated oil, to abort, 441 

Carbolic acid, 5 per cent, strength, injected 
into apex of boil when formation is 
assured, to abort, 442 

Chloride of calcium, added to poultice, 
hastens maturation, 105 

Collodion painted over inflamed spot, to 
abort ; if pus form it may be absorbed, 
if not, evacuate by incision, 441 

Egg-shells baked and eaten, for successive 
crops, 108 

Opium, locally applied to relieve pain and 
inflammation, 441 

Phosphorus, 297 

Poultices, containing sweet oil and lauda- 
num, to assist maturation, 441 

Prescription for ointment, 442 

Silver nitrate (gr. 20 to the ounce [1.3 : 
32.0]), painted over part, may abort, 
266, 441 

BREATH, FOETID. 

Camphor, as a mouth-wash, 109 

BREASTS (INFLAMED), 442 

Aconite or veratrum viride, to depress cir- 
culation, 442 

Belladonna, internally or as an ointment, 
before and after inflammation, with 
sponge compresses to breast, 442 

Breast-pump, if milk continue to form, 442 

Purges, mild saline, 442 

BONE DISEASE. 

Iodide of iron, syrup of, if anaemia exist, 
216 

Iodine ointment, diluted one-half, or tinc- 
ture, locally applied, 216 

BRIGHT' S DISEASE (ACUTE), 442 

Aconite, to depress circulation, 442 

Blisters contraindicated, 442 

Bromides or opium, given cautiously, if 

aconite fails to quiet restlessness, 442 
Caffeine, in later stages, 443 
Cannabis indica, if hematuria is present, 

also to allay pain over kidneys, 442 
Cantharides, 4 -drop (0.025) of tincture, 

about fifth day, when kidneys are atonic, 

also if hsematuria is present, 442, 443 
Citrate of potassium and sweet spirit of 

nitre, to increase flow of urine, 442 
Cups or leeches over loins if urine is 

scanty, 442 
Digitalis, with squill or calomel, gradually 

increased, followed by gin or compound 

spirit of juniper in later stages, 443 
Elaterium, to relieve dropsy, 443 



706 



INDEX OF DISEASES AND REMEDIES. 



Flaxseed tea, as a demulcent, 442 

Gallic acid and ergot, to control excessive 
haernaturia, 443 

Hot-air baths, useful to provoke sweat, 443 

Iron, if anaemia be present, also to decrease 
albuminuria, 443 

Juniper, to re-establish secretion, after in- 
flammation has subsided, 442 

Milk diet, 443 

Pilocarpine hydrochlorate, gr. ■£$ to \ 
(0.003-0.008), hypodermic-ally, if urae- 
mia threatens, repeated in fifteen min- 
utes if no sweat appears, but guarded by 
strychnine when the heart is weak, 443 

Potassium bi tartrate, 92 

Sulphate of magnesium, ^ss (16.0), to aid 
in elimination of toxic products by 
bowel, 442 

Turkish bath, to aid in eliminating effete 
products, used with care, 387 

BRIGHT S DISEASE (CHRONIC), 443 

Bichloride of mercury, 444 

Buttermilk useful, 444 

Cannabis iudica, to allay pain over kid- 
neys, also if haernaturia is present, 113 

Cantharides, particularly useful if due to 
alcoholism, 444 

Capsicum, to check albuminuria. 116 

Chloride of gold and sodium has been rec- 
ommended in interstitial forms, 444 

Chloride of iron if anaemia is present ; also 
to decrease albuminuria, 444 

Digitalis, to decrease albuminuria, 444 

Elaterium or jalap, to relieve dropsy, 444 

Lithium, carbonate or citrate, in gouty 
cases, 444 

Milk diet, 443 

Nitro-glycerin useful in ascending doses in 
chronic parenchymatous nephritis, 269 

Oxygen inhalations, 444 

Potassium acetate or bitartrate, alone, or, 
better, with gin or compound infusion 
of juniper, 444 

Potassium iodide, gr. 5 (0.3). thrice daily, 
used with great care, 213 

Protiodide of mercury useful, 444 

Sodium arsenite, gr. -£$ (0.003), in gouty 
cases, 444 

Squill, 444 

Strontium lactate for the relief of albu- 
minuria, 334 

Sugar of milk, 444 

Tapping to relieve ascites, 444 

Turkish and Eussian baths, relieve dropsy 
by increasing action of skin, 444 

BROMEDROSIS. 

Belladonna, 86 
Borax of great value, 93 
Salicylic acid, used as a dusting powder, 
prescription for, 316 

BRONCHITIS, 444 
Aconite, alone or combined with sweet 

spirit of nitre, in initial stage, 47, 445 
Amber, oil of, and. olive oil (1:3), applied 

to back and front of chest, in infantile 

bronchitis, 59 
Ammoniac, useful in old forms devoid of 

inflammation, 64 



Ammonium carbonate, alone or with the 
chloride, especially useful in children ; 
gr. 2 to 10 (0.1-0.65) in syrup of acacia, 
62 

Ammonium chloride, in second stage, to 
stimulate bronchial tubes, prescription 
for ; it may be applied alone in solution 
with atomizer, inhaled in fumes, 56, 447, 
448 

Antimony, to decrease inflammation of 
first stage ; only to be used when patient 
is strong and sthenic, 446 

Apomorphine, gr. T \ to J (0.006-0.015), as 
an expectorant in subacute stage ; if 
exudation accumulates rapidly, gr. £$ 
to iV (0.003-0.006), hypodermically, as 
an emetic, 449 

Asafcetida as a stimulating expectorant, 82 

Astringent sprays, often of value if secre- 
tion be excessive : tannic acid (gr. 2 to 
3 to the ounce [0.1-0.15 : 32.0]j, alum 
solution (a few grains to saturation), 
Monsel's solution (10 to 15 drops to the 
ounce [0.65-1.0:32.0]), lead acetate (gr. 
1 to 5 to the ounce [0.05-0.3 : 32.0]), 450 

Balsam of Peru, or Tolu, with other drugs, 
to decrease secretion in chronic stage, 
449 

Belladonna, to check excessive secretion 
and stimulate respiration, 448-450 

Benzoic acid, 90 

Bronchitis tent, 446 

Caffeine, or strong coffee, to stimulate res- 
piration if suffocation threatens. 450 

Camphor, in old or atonic cases, 109 

Codeine, recommended when cough is ex- 
cessive, 448 

Creosote, recommended in chronic bron- 
chitis, 170 

Croton oil and sweet oil (half and half), 
sometimes applied to chest, 172 

Cubebs or copaiba, as expectorants, liable 
to derange stomach, 449 

Digitalis, if heart be feeble, 450 

Dover's powder, gr. 5 to 10 (0.30-0.65), with 
a hot drink, useful in early stage, 445 

Dry cups applied on each side of the ver- 
tebrae, at sixth rib, or mustard or spice 
plaster to chest may relieve congestion. 
446 

Ethyl iodide, 5 to 10 drops (0.3-0.65), in- 
haled from a handkerchief every few 
hours in the later stages to loosen secre- 
tions, 187 

Eucalyptus oil, valuable in later stages ; 
dose, gr. 1 to 5 (0.05-0.3), in capsule, 
every three hours, 449 

Euphorbia pilulifera, £ to 1 drachm (2.0-4.0) 
of fluid extract in chronic bronchitis, 
190 

Flaxseed tea, a useful demulcent, 191 

Garlic, boiled, in milk or as a poultice, in 
later stages, 447 

Grindelia. very useful in later stages, 198 

Gurjun oil, when a powerful expectorant 
is desired, 200 

Inhalations of steam from boiling water, to 
relieve bronchial soreness, 446 

Ipecac, to promote secretion in first stage, 
also as an emetic when exudation accu- 
mulates rapidly and suffocation threat- 
ens, 445-449 



INDEX OF DISEASES AND REMEDIES. 



707 






Iodide of potassium, often useful when am- 
monium salts fail, contraindicated if se- 
cretion is excessive, 213 

Iodoform, to lessen cough and fetid dis- 
charge, 220 

Morphine, gr. ^ to T V (0.003-0.006), or 
chloroform, to quiet excessive cough, 
446 

Mustard foot-bath, with drinks of hot whis- 
key or brandy, in early stages, 445 

Myrrh, with expectorant mixtures, useful 
in later stages, 262 

Oxygen inhalations, when dyspnoea is 
great, 450 

Physostigma, in old persons with dilated 
tubes, as an expectorant and tonic to 
muscular fibres of tubes, 450 

Pilocarpine, to produce copious perspira- 
tion when patient is strong ; nausea 
may be produced, 445 

Potassium citrate with ipecac, to aid in 
formation of secretion, prescriptions, 
445 

Potassium cyanide for excessive cough, 174 

Pyridine as an inhalation, 447 

Quinine, ii fever be persistent, 446 

Resin, inhalations of fumes. 308 

Sandalwood oil, in later stages, dose 5 to 10 
minims, 449 

Sanguinaria, 319 

Senega, a stimulating expectorant in sub- 
acute and chronic stages, 324 

Squill, inferior to other drugs as an expec- 
torant, 449 

Strychnine, to stimulate respiration, if suf- 
focation threatens, 450 

Tar, 303 

Tartar emetic, as an expectorant, gr. -fa 
(0.001) hourly, or 1 drachm (4.0) of solu- 
tion (gr. 2 to the pint [0.1 : 500 cc.]), or 
as an emetic in sthenic cases, 69 

Terebene, if ammonium chloride fails ; 
dose, 5 to 10 minims (0.3-0.65), in cap- 
sule or emulsion ; must be stopped if 
kidneys or stomach are irritated, or 
used in an inhaler with equal parts of 
iodide of ethyl and chloroform, 448 

Terpine hydrate or terpinol in subacute or 
chronic types, 449 

Turpentine, inhalations or applied to chest, 
for children, diluted one-half with sweet 
oil, 447 

Veratrum viride, less severe than pilocar- 
pine in first stage ; dose, 2 to 3 drops 
(0.1-0.15) of tincture, 445 
Water, hot and cold dashes, if death is im- 
minent from suffocation, 450 

BRONCHOCELE. 

Potassium iodide internally, and tincture 
of iodine externally, best treatment, 
213 

BRONCHORRHGEA. 

Alum, applied in fine spray ; solution, gr. 
20 to the ounce (1.3 : 32.6), 58 

Gallic acid, 192 

BRUISES. 

Arnica, 77 

Liquor plumbi subacetatis, locally applied ; 
strength 1 to 4 ounces to the pint (32.0- 
128.0 : 500 cc.) ; contraindicated, if skin 



is broken ; also useful as lead-water and 
laudanum (water 16, lead-water 4, laud- 
anum 1), 236 

BUBO. 

Carbolic acid, solution (gr. 8 to the ounce 
[0.6 : 32.0]), 10-minim injections, pre- 
ceded by ether spray, 120 

Incision, at first sign of suppuration, fol- 
lowed by washing with either bichloride 
solution (1 to 1000), hydrogen peroxide 
(i strength), or zinc chloride (gr. 40 to 
the ounce [2.0 : 32.0]), 454 

Iodine, painted around spot with compress 
and spica bandage, or hot bag over 
swelling, 454 

BURNS AND SCALDS, 451 

Boric acid, solution, a useful dressing, 451 

Calcium carbonate, precipitated, as a dress- 
ing, 105 

Cantharides, tincture of (1 : 40), locally 
applied on lint if burn is not diffuse, 
451 

Carbolized sweet oil, cosmoline, or simple 
cerate, useful application to counter- 
irritation burns, 379 

Cold cream, as a dressing, 311 

Digitalis, in shock, if circulation fails to 
respond to less powerful stimulants, 451 

Ichthyol ointment, 211 

Lead carbonate, as an ointment, or with oil, 
as a dressing, 236 

Lime-water and linseed oil, equal parts, the 
best dressing. Carbolic acid is of ser- 
vice, added in proportion of 1 to 20, 451 

Morphine and atropine, gr. % to A (0.016- 
0.03) of former to gr. ^V (0.001) of lat- 
ter, to allay pain, 451 

Opium, to relieve pain, 280 

Potassium citrate with sweet spirit of nitre, 
if urine is high-colored, 452 

Poultice, applied to counter-irritation blis- 
ter, relieves pain ; when blister forms, 
puncture if large, allow to break if 
small, and dress with absorbent cotton, 
379 

Salicylic acid, prescription for, 316 

Sodium carbonate, solution, often relieves 
pain, 451 

Stimulants, if shock is severe, 451 

Zinc oxide, 284 

CAMPHOR-HABIT. 

Camphor monobromata, 111 

CANCER. 

Arsenic, small doses often repeated, to re- 
lieve vomiting and pain in gastric can- 
cer, 79 

Condurango, in the dose of 1 drachm (4.0) 
of the fluid extract, 166 

CANCRUM ORIS. 

Arsenic internally, 79 

Boric acid, as a mouth- wash, 93 

CARBUNCLE. 

Carbolic acid, solution (gr. 8 to the ounce 
[0.6 : 32.0]), hypodermic injections, to 
abort, 118 

Phosphorus, 278 



708 



INDEX OF DISEASES AND REMEDIES. 



CARIES. 

Lime salts, especially valuable in dental 
caries of nursing women, 106 

CATARRH OF AIR-PASSAGES. (See 

Nasal Catarrh.) 

Alum, applied in fine spray (gr. 20 to the 

ounce [1.3:32.0]), 58 
Arsenic, internally, 79 
Camphor, of service in old and atonic 

cases, 110 
Sozoiodol, applied locally in 5 per cent. 

solution, 330 

CATARRH OF BLADDER. 

Ammonium benzoate, to render urine acid, 61 
Juniper, a valuable stimulant in chronic 
cases, 231 

CATARRH OF UTERUS. 

Hydrastis, 204 

Sozoiodol, in powder, applied by tampon in 
catarrh of cervix uteri, 330 

CEREBRAL DISEASES. 

Blisters, to nape of neck in cerebritis, 377 
Croton oil, in cerebral congestion, 172 
Elaterium, in cerebral congestion, 179 
Phosphorus, often of service in cerebral 

softening, 278 
Veratrum viride, of greatest value in cere- 
britis during stage of hyperamria, after 
that period harmful, 397 

CHANCRE. 

Nitric acid, used as a caustic, surrounding 
tissues being protected by oil, 267 

CHANCROID, 452 

Acetaniiid, used in a dry powder, 43 

Actual cautery, the most destructive caus- 
tic, 452 

Bismuth and zinc oxide, or calomel and bis- 
muth, are substitutes for iodoform, 453 

Carbolic acid, as a wet dressing (gr. 5 to 
water oz. 1 [0.3 : 32.0]), 453 

Cocaine, 20 per cent, solution, to relieve 
pain of cauterization, 452 

Hot sitz-bath or general warm bath, 453 

Iodoform, the best dusting-powder after 
cauterizing, also useful as a palliative 
treatment, preceded by nitric acid wash 
(3j to water Oj [4.0 : 500 cc.]), in ero- 
sive chancroid, 453 

Iodol or aristol, as a substitute for iodo- 
form, 453 

Nitric acid, a good caustic, surrounding 
tissue being protected by oil, 452 

Opium, after cauterizing, 453 

Salicylic acid in powder or ointment, 316 

Sulphuric acid with charcoal, a good caustic 
and after dressing, 452 

Tannin, combined with dusting powder 
(1:4), if discharge is profuse, 453 

CHAPPING. 

Calcium carbonate, precipitated, as a local 

protective in intertrigo of infants, 105 
Calamine, in infantile intertrigo, 123 
Camphor, useful, added to precipitated cal- 
cium carbonate, in intertrigo, 109 



Cold cream, a useful application, 311 
Light magnesia, as a dusting-powder in in- 
tertrigo, 242 
Lycopodium, as a dusting-powder, 241 
Zinc oxide, in powder form, useful in inter- 
trigo, 285 

CHILBLAINS. 

Alum, as a wash, 58 

Capsicum, tincture, painted over parts or 

applied as a paper, prescription for, 117 
Ceratum resinre, 308 
Ichthyol ointment, 211 
Iodine ointment and lard, equal parts, gives 

great relief, 21 6 

CHLOROSIS. (See Anemia.) 

CHOLERA (ASIATIC), 454 

Camphor in the form of camphorated wine, 
of the greatest service in controlling 
cramps, 455 

Enemata of warm salt solution (£j to Oj 
[4.0 to 500 cc.]), highly recommended by 
Italian observers, 456 

Enteroclysis, associated with hot baths, ap- 
plication very valuable, 456 

Ether, subcutaneously, as a diffusible stim- 
ulant, 456 

Fly blister, over vagi, beneath jaw, highly 
recommended, 457 

Hypodermoclysis, very useful, 456 

Opium, if employed at all, should only be 
given hypodermically, 454 

Purgatives, contraindicated, unless bad food 
has been taken, 454 

Quarantine and strict hygiene, as a pro- 
phylactic, 454 

Salol, highly recommended by many emi- 
nent authorities, 456 

Sulphuric acid, with camphor, to control 
diarrhoea, 457 

Tannic acid, by enemata (Srj-viij to Oj 
[4.0-32.0 :500cc.]),457 

"Vagus," treatment of, 457 

CHOLERA INFANTUM, 457 

Arsenic, to check vomiting, prescription 
for. 459 

Beef-juice, as a food especially valuable, 
459 

Brandy, if vomiting is active and collapse 
threatens, a few drops to drachm (4.0) of 
nourishment, 458 

Castor oil, with paregoric, to empty bowels 
and allay irritation, 458 

Cold drinks, pieces of ice, and antipyretics, 
if rectal temperature is above normal, 
457 

Diet, 459 

Enteroclysis, very valuable, 459 

Hot drinks, applications, and baths if rectal 
temperature is subnormal, temperature 
being watched, 458 

Iodoform and oil injections to relieve tenes- 
mus, 221 

Irrigation of bowels, 460 

Laudanum, gtt. 10 (0.65), starch-water, 
drachm 3 (12.0), by enema, and calomel 
gr. Jo (0.005) or gray powder gr. h (0.01) 
by mouth, to control vomiting and purg- 
ing, if severe, 459 



INDEX OF DISEASES AND REMEDIES. 



709 



Mustard or spice plaster, over belly, always 

useful, 460 
Podophyllin, if stools are of peculiar pasty 

color, 458 
Predigested milk or beef juice, the best 

food, 458 
Prescriptions for, 459 

CHOLERA MORBUS, 460 

Camphor, 109 

Castor oil, with laudanum, to sweep out 
intestines, before diarrhoea mixture is 
used, 460 

Ipecac, gr. 3 (0.15) every two hours, often 
of service, 222 

Mustard or capsicum plaster, over abdo- 
men, 460 

Prescription for, 460 

CHORDEE, 529 

Aconite, often relieves, 47 

Belladonna internally and ointment ap- 
plied to under surface of penis, 87 

Bromide of potassium, dr. 1 (4.0) at bedtime, 
repeated during night if necessary, 529 

Camphor with bromides, very useful in 
some cases, 109 

Cantharides, gtt. 1 (0.05), thrice daily, 115 

Hot sitz-bath and steeping penis in hot 
water before retiring, relieves, 386 

Lupulin, gr. 30, 529 

Morphine, gr. i (0.016), with atropine gr. 
-^ (0.001), hypodermically into peri- 
neum, to relieve, 529 

Opium or belladonna suppositories, to re- 
lieve, 529 

CHOREA, 461 

Arsenic, in ascending doses ; discontinue if 
symptoms of poisoning ensue, 461 

Bromides with chloral, when there is in- 
somnia, prescription for, 461 

Chloroform inhalations when excessive, 
145 

Cimicifuga alone, or with iron, very useful, 
461 

Hot pack, at bedtime if muscular jerkings 
are severe, 461 

Monobromated camphor, 111 

Nitro-glycerin, 268 

Quinine in full doses, 462 

Salicylates or iodides of value, if asso- 
ciated with rheumatism, 461 

Silver oxide and nitrate, occasionally used, 
not reliable, 462 

CHOROIDITIS, 462 

Venesection in early stage, followed by 
mercury or potassium iodide, 462 

CINCHONISM. 

Potassium bromide, as a preventive, 98 
CIRRHOSIS OF LIVER. (See Hepatic 
Cirrhosis.) 

COLDS. (See Coryza.) 

COLIC. 

Asafcetida, useful in children, 82 
Chloral and bromide, when severe in chil- 
dren ; prescription for, 130 
Ether internally, very useful, 186 



Hoffmann's anodyne, 202 

Hyoscyamus, 209 

Matricaria, infusion, to prevent, in teeth- 
ing children, 244 

Mustard plaster, i to i (0.016-0.03) strength 
if skin is tender, 561 

Bue, as a carminative, 312 

COLIC, HEPATIC, 462 

Belladonna, in full dose, to relax spasm, 89 

Chloroform or ether, inhalations to relieve 
pain during spasm, 463 

Diet, 463 

Hot applications over liver, as a relaxant, 
462 

Morphine, gr. I or £ (0.016-0.03) with atro- 
pine gr. ^ hypodermically, to relieve 
pain, 462 

Olive or cotton-seed oil, H pints (750 cc), 
during attack ; ether, drachm 1 (4.0), 
may be added with advantage, 462 

Opium with belladonna, to relieve pain and 
spasm, 279 

COLIC (RENAL). 
Belladonna, in full dose, 87 
Chloroform, a few inhalations often relieve, 

146 
Opium with belladonna relieves spasm and 

pain, 279 

COLLAPSE. 

Digitalis, 177 

Ether, by mouth, inhalations, or hypoder- 
mically of great service, 186 

CONDYLOMATA. 

Calomel, as a dusting-powder, often re- 
moves, 254 

CONGESTION. 

Croton oil, as a revulsive in cerebral con- 
gestion, 172 

Digitalis, relieves stasis of congested lung 
in typhoid state, 177 

Elaterium, in cerebral congestion, 179 

Ergot of service, especially with digitalis, 
181 

Glycerin, on cotton tampon, as a depletant 
in uterine congestion, 197 

Juniper, often relieves congested kidneys, 
231 

CONJUNCTIVA (BURNS OF), 464 

Atropine incorporated with liquid vaseline 
instilled into eye, to prevent iritis, 465 

Cod-liver oil, instilled into eye after re- 
moval of foreign matter, 464 

Gold-beater's skin inserted between lids 
and eyeball or breaking up granula- 
tions prevents corneal inflammation, 464 

Neutralization of foreign matter, if acid or 
alkaline, 464 

CONJUNCTIVA (CHEMOSIS OF), 467 

Astringent washes, especially alum, 467 
Nicking swollen tissue with scissors, 467 
Warm moist compresses, 467 

CONJUNCTIVA (HEMORRHAGE 
BENEATH), 467 
Boric-acid or cocaine wash, when conjunc- 
tival irritation exists, 467 



710 



INDEX OF DISEASES AND REMEDIES. 



Massage of globe through closed lid, to aid 
absorption of blood, 467 

CONJUNCTIVA (XEROSIS OF), 467 

Glycerin, almond oil, cod-liver oil, or weak 
alkaline washes, 467 

CONJUNCTIVITIS (CHRONIC), 465 

Boric acid, wash (gr. 10 to the ounce [0.65 : 
32.0]), cocaine, gr. 2 (0.1), may be added 
if there is no corneal ulcer; for this 
condition salt, gr. 4 to the ounce (0.3 : 
32.0), may be substituted, 465 

Copper, crystal, or a solution (gr. 1 to 3 to 
the ounce [0.05-0.15 : 32.0]), applied to 
diseased spot, if subacute, 169 

Correction of refraction error, if it be pres- 
ent, 465 

Lapis divinis, 465 

Tannin and glycerin (gr. 10 to the ounce 
[0.65 : 32.0]), as an application, 465 

Yellow oxide or sulphate of mercury, salve 
or alum crystal, useful application, 465 

Zinc oxide, in powder or the sulphate in 
the form of a wash, 285, 336 

CONJUNCTIVITIS (DIPHTHERITIC), 467 

Atropine instilled, 469 

Boric-acid or bichloride solution, frequently 
applied in early stages, 467 

Cade, oil of (strength 1 to 10), 467 

Citric-acid ointment or lemon -juice, locally 
applied, 467 

Hot compresses, 467 

Quinine, solution (gr. 3 to the ounce [0.15 : 
32.0]), 467 

Silver nitrate, same as in purulent conjunc- 
tivitis, 467 

Sulphur, insufflations, 467 

CONJUNCTIVITIS (FOLLICULAR), 466 

Alum, crystal applied locally if due to atro- 
pine instillations, 466, 58 

Astringent and antiseptic lotions, 466 

Calomel, as a dusting-powder, alone or with 
bismuth, aristol, or iodoform, 466 

Copper sulphate, as an ointment (gr. h to the 
drachm [0.3:4.0]), 466 

CONJUNCTIVITIS (GRANULAR), 466 

Alum, in stick or crystal, 58 

Atropine, instillations, in acute forms, 466 

Boric acid or salicylic acid, solution, as a 

wash in acute forms, 466 
Boroglyceride (20 to 50 per cent.), applied 

to chronic granulations, 466 
Carbolic acid, applied pure, to chronic 

granulations; excess removed with 

water, 466 
Copper sulphate, crystal, applied to chronic 

granulations, 466 
Corrosive sublimate, solution (1 : 200 or 1 : 

500), applied every second day in 

chronic forms, preceded by cocaine ; 

eyes also being irrigated thrice daily 

with solution (1 : 7000), 466 
Crushing granulations, often satisfactory, 

466 
Excision of granulations when isolated, 

466 
Glycerol e of tannin, applied to chronic 

granulations, 466 



Leeches, to temple, to reduce inflammation 

in acute stage, 466 
Liquor potassa, beta-naphthol, iodoform, 

aristol in powder or salve, yellow-oxide 

ointment, calomel, or hydrastine may be 

tried, 466 
Scarification, not advisable, 466 
Silver nitrate, stick or solution (gr. 10 to the 

ounce [0.65 : 32.0]), applied daily, if 

there is discharge ; neutralize excess 

with salt solution, 466 
Yellow oxide of mercury, ointment, with 

lard equal parts, in chronic types, 257 

CONJUNCTIVITIS (LACHRYMAL), 465 
Treatment same as for chronic type. 

CONJUNCTIVITIS (MUCO-PURULENT). 

Treatment same as for purulent type. 

CONJUNCTIVITIS (PURULENT), 464 

Atropine or eserine, if corneal ulcer ap- 
pears, 465 

Bichloride of mercury (1 : 8000), or boric 
acid (saturated solution), as a wash, used 
hourly, 464, 465 

Hot compress, in lieu of cold, if vitality of 
cornea is threatened, 464 

Iced compress, in early stage, to reduce in- 
flammation, 464 

Leeching, useful if inflammation is high, 
contraindicated in infants, 465 

Permanganate of potassium, aqua chlorini, 
sulphocarbolic-acid solution, alum sul- 
phate, zinc sulphate, creolin (1 percent.), 
or iodoform ointment may be tried, 465 

Peroxide of hydrogen useful as a cleansing 
agent, 465 

Pyoktanin, not satisfactory, 465 

Silver nitrate, stick or solution (gr. 10 to 
the ounce [0.65 : 32.0]), touched to lids 
after cleansed of pus, excess neutralized 
with salt solution; 2 per cent, solution 
dropped in new-born infant's eyes to- 
prevent, 464 

Sozoiodol (2 : 30), 330 

CONJUNCTIVITIS (SIMPLE), 463 

Alum curd or solution (gr. 4 to 8 to the 
ounce [0.25-0.6 : 32.0]), or application 
of stick, if there is chronic tendencv, 
464, 57 

Atropine usually unnecessary unless cor- 
neal ulcer is present, 463 

Boric acid, lotion (gr. 10 to the ounce [0.65 : 
32.0]), 463 

Cold compress, dipped in water, and hama- 
melis (equal parts), to allay inflamma- 
tion, 463 

Creolin solution (1 per cent.), 463 

Eye-wash, to allay irritation, prescription 
for, 94 

Mercury, bichloride solution (1 : 10,000), if 
discharge is great, 463 

Peroxide of hydrogen, 463 

Poultices and bandages contraindicated, 
463 

Pyoktanin (1 : 1000), 463 

Silver nitrate, solution (gr. 2 to 5 to the 
ounce [0.1-0.3 : 32.0]), if there is muco- 
purulent discharge. If discharge is ex- 



INDEX OF DISEASES AND REMEDIES. 



711 



cessive employ gr. 10 to the ounce (0.65 : 
32.0]), and neutralize excess with salt 
solution or wash with tepid water, 463 

Smoked glasses, 463 

Sodium biborate, gr. 4 to 8 to ^j (0.3 to 0.5 : 
32.0), 463 

Tannin and glycerin (gr. 10 to the ounce 
[0.65 : 32.0]), or alum crystal if there is 
a chronic tendency, 464 

Zinc sulphate, solution (gr. 1 to 2 to the 
ounce [0.05-01:32.0]), alone or with 
boric acid, if there is chronic tendency, 
463 



CONSTIPATION, 468 

• Aloes and podophyllin, with other drugs, 
useful for temporary use ; prescription 
for, 470 

Belladonna, 83 

Cascara sagrada, the best curative agent, 
dose gtt. 10 to 20 (0.05-1.3) of fluid ex- 
tract or drachm 1 (4.0) to 6 (24.0) of 
cordial, 478 

Castor oil, following acute disease in chil- 
dren, ultimately harmful in all cases, 
470 

Colocynth. jalap, or senna, not to be used 
constantly, 470 

Diet, of extreme importance, 469 

Enemata, as a routine treatment harmful, 
471 

Glycerin, suppositories or enemata, often 
used. 471 

Gymnastic movements, horseback riding, 
or massage, with regulated diet, 469 

Hunyadi, Carlsbad, or Friedrichshall wa- 
ters, rarely of value, 470 

Leptandra, fluid extract of, in intestinal 
atony, 238 

Magnesium sulphate by the mouth or by 
enema, 243 

Manna, as a laxative fruit for adults, or 
drachms 1 to 2 (4.0-8.0) to bottle of milk, 
for infants, 470 

Mercury, as an habitual purgative harmful, 
470 

Opium, 471 

Oxygen-water, before retiring, in constipa- 
tion due to intestinal atony, 285 

Phosphate of sodium, useful in rickety 
children, 2 to 4 (0.1-0.2); or adults, 
470 

Rhubarb, usually harmful, in some cases in 
children useful, 470 

Salines, simply to unload bowels, 470 

Seidlitz powder, 324 

Senna, said to be useful in constipation of 
pregnancy. 325 

Soap suppositories, useful in children, 326 

Stiiliugia, recommended when habitual ;" 
prescriptions for, 333 

Sulphur, especially valuable if hemorrhoids 
are present, 339 

Tobacco, sometimes used, 471 



CONVULSIONS. 

Allium, as a poultice over spine or feet in 
infantile spinal or cerebral convulsions, 
54 

Amyl nitrite, 65 



Chloral with bromide, in infants; also 
useful alone in uremic and puerperal 
convulsions, if no acute renal trouble 
exists, 130 

CORNS. 

Fowler's solution, locally applied, 79 
Salicylic acid, the best application, formula 

for, 472 
Silver nitrate, solution (gr. 60 to the ounce 

[4.0 : 32.0]), applied to soft corns every 

four or five days, 473 

CORYZA, 472 

Aconite, useful in early stages, 47 

Allium, as a poultice to breast, or in emul- 
sion or boiled in milk, for children, 53 

Arsenic, taken for months, often cures per- 
sistent colds, 78 

Antipyrine, in 2 to 4 per cent, solution as a 
spray, preceded by a cocaine spray, 73 

Bromides useful in headache, 473 

Camphor, as a snuff, or inhalation of spirit 
or fumes, when sneezing and lachryma- 
tion are excessive, 110 

Cocaine, a few minims of a 4 per cent, solu- 
tion dropped into nostril, followed by 
lotion (see prescription) with atomizer 
or cocaine (1 part ), morphine (1 part), 
and bismuth (7 parts) as a snuff, 472 

Cubebs, as a snuff during stage of secretion, 
173 

Glycerin, applied alone by brush or spray, 
often of service, 194 

Hamamelis, useful after acute stage is past, 
201 

Hot mustard foot-bath with hot draught < r 
Dover's powder, followed by rest in bed, 
may relieve, 473 

Menthol, very useful, 290 

Prescription for wash, 472 

Quinine, internally, combined with chloride 
of ammonium, useful after secretion 
is established, 473 

Sweet spirit of nitre, 243 

COUGH. 

Acacia, as a mucilaginous drink with flax- 
seed and liquorice, to loosen hacking 
cough, 39 

Almonds, essential oil, in emulsion, as a de- 
mulcent in cough of phthisis, 54 

Belladonna, the best remedy in nervous 
cough, 86 

Cannabis indica, a useful adjunct to cough 
mixtures, 112 

Chloroform, useful, added to cough mixtures 
for irritant cough, 145 

Flaxseed tea, alone or with paregoric, a 
useful demulcent in excessive cough, 
191 

Gelsemium, 193 

Hydrocyanic acid, highly recommended, 
prescription for, 206 

Hyo-cyamus, 207 

Iodine, as a paint over supraclavicular 
spaces, in irritative cough, 216 

Ipecac, in spray, useful in chronic winter 
cough, 222 

Morphine in wild-cherry syrup, useful in 
irritative cough and when cough is 



712 



INDEX OF DISEASES AND REMEDIES. 



greater than necessary to expel mucus, 
280 

Paregoric (1 drachm [4.0]) in hot water, 
from which the steam is inhaled, useful 
in irritative form of cough, 280 

Sandalwood oil for excessive cough follow- 
ing influenza, 319 

CRAMPS. 

Belladonna, internally or locally as a lini- 
ment, 86 
Chlorodyne, for stomach cramp, 136 
Ginger, especially useful in menstrual 
cramp due to cold, 195. (See Dysnienor- 
rhcea.) 



CROUP (MEMBRANOUS). 

Diphtheria.) 



(See 



CROUP (SPASMODIC), 473 

Aconite, useful, 47 

Amyl nitrite, inhalations, if paroxysm is 
severe, 473 

Antimonial wine, drachm 1, to cause vom- 
iting if paroxysm is severe, 474 

Belladonna, bromides, chloral, or opium in 
small doses at bedtime, as a preventive, 
473 

Bromides and lactucarium, 473 

Cold cloth around neck, and child placed 
at once in hot bath, air of room being- 
moistened by steam, 473 

Menthol, useful, 473 

Prophylactic measures, 473 

Sanguinaria, as an emetic, unfavorable, 320 

Spongio-piline or flannel, wet with hot 
water, applied to neck and covered with 
oiled silk or cotton, 437 

CYSTITIS (ACUTE), 474 

Aconite in full dose, with sweet spirit of 
nitre and potassium citrate if there is 
fever ; prescription for, 474 

Belladonna, alone or with aconite, espe- 
cially useful if due to cold ; dose gtt. 5 
to 10 (0.3-0.65) thrice daily, 474 

Boric acid, to render urine acid, 93 

Cannabis iudica, preferable to opium for 
relieving pain v 474 

Creolin, as a vesical wash (1 to 2 per cent, 
solution) in cystitis of women, 172 

Flaxseed tea, as a demulcent. 191 

Hot compress over bladder, should not con- 
tain irritants. 474 

Hot sitz-bath and enemata, to relieve bear- 
ing-down pain, 474 

Hygienic measures, 474 

Laudanum, gtt. 30 (2.0), to starch-water, 
oz. 2 (64.0), in enema, to relieve bearing- 
down pain, 474 

Leeches to perineum or cups to sacrum, 
474 

Opium, belladonna, or iodoform supposi- 
tory, to allay bearing-down pain, 474 

Quinine, contraindicated. 475 

Salines, in early staa;e to evacuate bowel, 
475 

Salol, gr. 10 (0.65) thrice daily if inflamma- 
tion becomes purulent, 475 

CYSTITIS (CHRONIC), 475 

Arbutin, gr. 3 to 5 (0.15-0.3), or fluid extract 



of buchu or uva ursi, h to 14 drachms 
(2.0-4.0), to improve vesical mucous 
membrane when inflammation is of sub- 
acute type, 476 

Benzoic or boric acid, gr. 5 to 10 (0.3-0.65) 
in pill, to render urine alkaline, 475 

Creolin solution (1 to 2 per cent.) as a vesi- 
cal douche, 476 

Grindelia, as a vesical stimulant, 198 

Mercury, bichloride solution (1 : 10,000), as 
an injection to cleanse bladder, 475 

Opium suppositories, gr. i to i (0.016-0.03), 
very useful, 280 

Potassium salts, except bitartrate, to ren- 
der urine alkaline when mucus is ex- 
cessive, 475 

Turpentine, oil of sandalwood, cubeb, or 
copaiba, useful when vesical atony is 
great, 476 

Silver nitrate, solution (gr. 1 to oz. 4 [0.05 : 
128.0], increased gradually to gr. 2 to 
oz. 1 [0.1 : 32.0] j, as an injection when 
discharge is muco-purulent, followed by 
salt solution if pain is severe, 475 

Strychnine and cantharides, when vesical 
atony is great, 476 

DEBILITY. 

Arsenic, with bitter tonics, very useful. 78 

Calomel, in debility of cbildren. often re- 
lieves, 253 

EJhpatorium, a good tonic, 189 

Lime salts, 106 

Phosphorus, of service in sexual debility, 
297 

DELIRIUM TREMENS. 

Chloral, of great service used cautiouslv. 

131 
Croton oil, 172 
Hops, 203 

Hyoscine, in insomnia, 209 
Monobromated camphor, when nervous 

twitching is troublesome, 111 
Valerian with morphine, frequently- used, 

352 

DIABETES INSIPIDUS, 476 

Arsenic, 79 

Belladonna or opium, if due to nervous 
irritability, 476 

Carbonate or citrate of lithium, gr. 10 (0.65), 
with sodium arsenite, gr. ^ (0.002), val- 
uable in gouty types, 240 ■ 

Ergot, 476 

Gallic acid, alone or with opium, one of the 
best remedies, 476 

Rhus aromatica, highly recommended, 310 

Strychnine and sulphate of iron, as tonirs, 
476 

DIABETES MELLITUS, 476 

Acidulated water or non-purgative alkaline 
water, to allay thirst, 478 

Almond bread or bran bread, as a food for 
diabetics, 51, 411 

Alum, 58 

Antipyrine, when of gouty origin. 73 

Carbonate of sodium, by injection in dia- 
betic coma. 479 

Chloride of gold and sodium, gr. r ^ (0.006), 
recommended, 474 



INDEX OF DISEASES AND REMEDIES. 



713 



Codeine, in ascending doses, beginning gr. 

1 to 5 (0.05-0.25), thrice daily, 160 
Colckicuru and iodides, in gouty types, 477 
Diet, 476 

Ergot, highly recommended, 477 
Ether, hypodermically, to support heart in 

diabetic coma, 479 
Gallic acid, with opium, one of the best 

remedies, 192 
Glycerin or saccharin, as sweetening agents 

to replace sugar, 477 
Iodol, gr. 2 to 6 (0.1-0.3), thrice daily, rec- 
ommended, 221 
Iron, lacto-phosphates of lime and sodium, 

strychnine and astringeuts, if cachexia 

comes on, 478 
Jumbul, gr. 5 to 30 (0.3-2.0). once to thrice 

daily, said to be very useful in some 

cases, 478 
Lime-water, 103 
Lithium carbonate or citrate, with arsenic, 

very useful, if due to gout, 477, 79 
Morphine, very useful in ascending doses, 

477 
Opium, gr. I to h (0.016-0.03), thrice daily, 

largely used, 477 
Purgatives, restricted diet, and exercise, if 

due to high living and sedentary habits, 

477 
Salicylates and iodide of potassium, if due 

to rheumatic or gouty taint, 477 
Soya bran bread, 330 

DIARRHOEA, 479 

Ammonium chloride, gr. 5 (0.3) every four 
hours, best remedy in persistent catar- 
rhal states, 4S0 

Arsenic, 79 

Belladonna, may be used in serous type, 87 

Bichloride of mercury, gr. 5 ^ (0.0006) 
hourlv, if stools be slimy and bloody, 
482 

Bismuth, with carbolic acid, gtt. 1 or 2 
(0.05-0.1) highly recommended in se- 
rous and summer diarrhoeas, 481 

Cajuput, gtt. 10 to 20 (0.65-1.3) in serous 
forms, 104 

Calomel, followed by a saline, useful in 
sthenic cases of summer diarrhoea, 481 

Calumba, in summer and serous diarrhoeas, 
prescription for, 107 

Camphor, useful in serous but never in mu- 
cous types, 109 

Carbolic acid, especially useful as an intes- 
tinal antiseptic, 482 

Castor oil, with laudanum and sodium bi- 
carbonate, to unload bowel and render 
it alkaline, 479 

Catechu, alone or with opium, in serous 
types, prescription for, 126 

Chalk mixture, with kino and catechu, in 
serous diarrhoeas, prescription for, 105 

Charcoal, useful in acid and fermentative 
types, 121 

Chirata, nitro-muriatic acid, or, better still, 
nitric acid and cardamoms, in mucous 
type, prescription for, 480 

Chlorodyne, largely used in serous types, 
136 

Chloroform, with astringents and opium, 
very useful after removal of irritant 
cause, 146 



Cinnamon, as a stimulant, in serous types, 
154 

Cloves, 156 

Copper sulphate, gr. | (0.016) with opium, gr. 
1 (0.06) in pill, or in enema, (gr. 5 to 20 
to the ounce [0.3-1.3 : 32.0]), if due to 
ulceration, 169 

Diet, for summer diarrhoea, 482 

Ergot, sometimes useful in serous types, 181 

Gallic acid, 192 

Geranium, 1 or 2 roots, boiled in pint of 
milk, of great service in infantile types, 
195 

Ginger, a good addition to diarrhoea mix- 
tures, 195 

Haeinatoxylon, useful in children, because 
of agreeable taste, 200 

Hope's camphor mixture, in serous and 
choleraic types, 204 

Ipecac, gr. ± to h (0.016-0.03), thrice daily, 
useful in summer diarrhoea of children, 
481 

Kino powder, formula for, 232, 480 

Kola, useful in some obstinate chronic cases. 
232 

Lead acetate, with opium and camphor, in 
serous type, prescription for, 236, 480 

Mercury, with chalk or calomel, in hepatic 
disorder, 481 

Morphine, gr. ^ to - 5 V (0.0008-0.0012), hypo- 
dermically, often checks summer diar- 
rhoea in children, 281 

Mustard plaster, or other counter-irritants, 
to abdomen, 479 

Naphthalin or naphthol, in fetid and sum- 
mer diarrhoeas, 262 

Nitrate of silver and hyoscyamus, or lead 
acetate and opium, in mucous diarrhoea, 
prescription for, 479 

Nitro-muriatic acid, or podophyllin, gr. ^ 
to 5V (0.0012-0.0016), in summer diar- 
rhoea, if duodenum is at fault, 431 

Nutmeg, useful in serous types, 272 

Pepsin with hydrochloric acid, in summer 
diarrhoea, if gastric digestion is deficient, 
481 

Phosphate of sodium, lime salts, and com- 
mon salt in summer types, if rickets is 
present, 481 

Potassium iodide, gr. 3 to 5 (0.15-0.3), if 
catarrhal state is obstinate, 480 

Raspberry-leaves, used in domestic medi- 
cine, 311 

Rhubarb, often useful, preceding direct 
treatment in summer diarrhoea, 310 

Sulphocarbolate of zinc, 2 grains every 
three hours ; of service in summer diar- 
rhoea, 482 

Salol combined with chalk mixture, 482 

Sulphuric acid, especially valuable in serous 
types, prescription for, 480. 481 

Tannic acid, in atonic or serous types, 344 

Tar mixture, highly recommended in ob- 
stinate types, formula for, 304 

Thymol, naphthalin, and especially sali- 
cylic acid, useful as intestinal antisep- 
tics, in summer diarrhoea, 481 

Zinc oxide, in summer types, prescription 
for, 284 

Zinc sulphate, 2-grain (0.1) pills, especially 
useful with opium, or podophyllin, gr. 
^ (0.001), in serous types, 336 



714 



INDEX OF DISEASES AND REMEDIES. 



DIARRHCEA (CHRONIC), 483 

Bismuthi et ammonii citras, in chronic se- 
rous types, 91 

Diet, 483 

Iron sulphate, gr. 5 (0.3) in pill, in chronic 
types, 229 

Nitric acid, with a bitter tonic, useful in 
green diarrhoea of children ; combined 
with Fairchild's essence of pepsin, re- 
lieves chronic types in children, 267 

Operative procedures when due to lesions 
of the rectum, 484 

Silver nitrate in pill form, or in other cases 
rectal injections of this drug, gr. 2 to^j 
(0.1 : 32.0), followed by iodoform sup- 
pository, of greatest benefit, 484 

Sodium bicarbonate, gr. 5 to 20 (0.3-1.3), 
and iodoform suppositories, by their 
combined action, give great relief, 484 

DIPHTHERIA, 484 

Aconite, in early stages, 47 

Antitoxin, of great value ; 5 to 10 cubic 
ceutimetres should be thrown iuto the 
connective tissues of the back. A spe- 
cial syringe is used for this purpose, and 
should be perfectly aseptic, 486 

Carbolic acid (1 : 100 j in the form of spray 
or gargle, 120 

Chlorate of potassium, contra indicated for 
internal use, because of dauger to the 
kidneys. It may be applied upon a 
swab, 133, 485 

Corrosive sublimate, gr. £ 6 (0.0012), or calo- 
mel gr. £ to ^ every hour, unless diar- 
rhoea or ptyalism be produced, 484 

Ice-bags to the neck, ice in the mouth and 
the tincture of the chloride of iron in- 
ternally, if glandular suppuration 
threatens, 485 

Iodine, inhalations, 218 

Loeflier's application (menthol, 2 J o (10 
grms.), dissolved in 9 3 (36 cc.) of 
toluol ; add 1 5 (4 cc.) of liquor ferri 
chloridi and absolute alcohol, 2 f^ 
(60 cc), 487 

Milk diet, 484 

Monsel's solution, as a topical application, 
228 

Oxygen inhalations, strychnine, and atro- 
pine if suffocation is imminent. In- 
tubation or tracheotomy may be neces- 
sary, 485 

Peroxide of hydrogen is the best local' ap- 
plication. May be applied on a swab or 
as a spray (1 : 4), to remove false mem- 
brane, 484 

Potassium permanganate, solution (gr. 20 to 
the pint [1.3 : 500 cc.]), applied as a swab 
or gargle, 291 

Salt solution (7 : 1000), as a spray in nasal 
diphtheria, 484 

Tonics, such as quinine, strychnine, and 
the chloride of iron, as supportive meas- 
ures, 484 

Turpentine, by inhalation, prescription for, 
485 

DROPSY, 487 

Acupuncture, less favorable than incisions, 
only to be resorted to after other rem- 
edies fail. 490 



Adonidin, sparteine, or strophanthus, if 

other drugs fail, 490 
Caffeine, in torpidity of kidneys, 490 
Calomel and digitalis, in renal and cardiac 

types, 490 
Colocynth, compound extract of, gr. 2 to 6 

(0.1-0.3), 489 
Copaiba, of service in slow renal types, 168 
Digitalis, gtt. 5 to 10 (0.3-0.65), with can- 

tharides, gtt. 1 (0.05), thrice daily, in 

renal torpidity due to heart trouble, 

490 
Elaterium, especiallv useful in renal dropsv, 

489 
Jalap, compound powder of, gr. 20 to 30 

(1.3-2.0), with potassium bitartrate, gr. 

10 (0.65), added, especially serviceable 

in renal dropsy. 489 
Magnesium sulphate, in concentrated solu- 
tion, before breakfast, 489 
Milk diet, very useful. 489 
Paracentesis abdominis, very useful in as- 
cites, 490 
Pilocarpine, useful in localized dropsy, con- 

traindicated in cardiac types, 490 
Potassium iodide, in hepatic cirrhosis and 

localized effusions, to remove liquid, 

490 
Scoparius, infusion, may be used, 490 
Senega, rarely of value. 324 
Squill with digitalis, prescription for, 332, 

490 
Sugar of milk, useful as a diuretic, 489 
Tapping in ascites, the best method, 493 

DYSENTERY, 482 

Alum, internally, 58 

Bichloride of mercury, gr. T ^ (0.0006) (or 
gr. h [0.025] in water 5 ounces [160.0]), 
teaspoonful hourly till relieved, 482 

Bichloride of mercury, injections (1 : 5000), 
followed by solution(l : 30,000)to prevent 
toxic effect by absorption, 483 

Boracic acid, £j to Oj (4.0 : 500 cc), or sul- 
phocarbolate of zinc, gr. 15 to 1 quart 
(1.0 : 1000 cc ), very useful as rectal in- 
jection, 483 

Calomel, in purgative dose, contraindicated 
if weakness exists, 482 

Continuous irrigation with two-way tube, 
of great value, 483 

Copaiba, 168 

Ergot, useful in bloody stools, 181 

Hamamelis, injections, if much blood is 
present, 482 

Ice-water, injections, if due to inflamma- 
tion, used only in strong persons, 482 

Ipecac, best remedy in acute dysentery, 
222 

Lead acetate, with opium and camphor, pre- 
scription for, 236 

Nitro-hydrochloric acid, if due to defective 
action of secretory glands, 270 

Prescription for enema, 482 

Quinine injections useful in amoebic dys- 
entery, 152, 483 

Silver nitrate, rectal injections (gr. 10 to 20 
to the pint [0.6-1.3:500 cc.]), if ulcers 
are chronic ; followed by salt solution 
if action is too severe, 482 

Tannic acid (£j [4.0] to water Oj [500 cc] ), 
in the form of intestinal irrigation, 483 



IXDEX OF DISEASES AND REMEDIES. 



715 



DYSMENORRHEA, 491 

Amyl nitrite, often relieves, 65 

Antipyrine or acetanilid, in neuralgic at- 
tacks, in other cases of doubtful value, 
492 

Belladonna, suppository, gr. \ (0.03) of ex- 
tract, or ointment applied to os ; tinc- 
ture, internally, useful to relax spasm, 
491 

Camphor with acetanilid, in pill, useful in 
nervous cases, 109 

Cannabis indica and gelsemium, often of 
service, 492 

Epsom salts or aloes, if constipation is 
present, 491 

Hot sitz-bath, followed by turpentine stupe, 
and Dover's powder, gr. 10 (0.65), often 
relieves, 491 

Iron, strychnine, and quiniue, as tonics, 
with rest and horseback riding for anse- 
mic and run-down patients, 491 

Opium, to relieve spasm and pain, contra- 
indicated. 491 

Piscidia erythrina, extract, in the dose of 
from \ to 2 fluidrachms (2.0-8.0), 303 

Potassium bromide, 97 

Water, cold and hot, alternately dashed 
over loins in atonic cases, 492 

DYSPEPSIA. (See Indigestion.) 
Arsenic, useful in atonic types associated 

with chronic diarrhoea. 78 
Bismuth, when due to acid fermentation, 

91 
Hydrastis, as an antiseptic and curative 

agent in chronic types, 205 
Hydrochloric acid, if gastric secretion is 

deficient, 205 
Lavage in fermentative dyspepsia, 392 
Nitric acid with bitter tonics often relieves 

intestinal types, 267 
Oxygen-water, often useful in chronic 

types, 285 
Permanganate of potassium, 291 
Quassia, useful, if not due to gastritis, 307 
Serpentaria. as a tonic in atonic types, 326 
Strontium bromide, in painful dvspepsia, 

334 
Terebene, useful as an antiseptic in fer- 
mentative dyspepsia, 345 

DYSPNOZA, 492 

Ammonium carbonate, as a respiratory and 
cardiac stimulant, 493 

Arsenic, continuously employed, useful in 
emphysema and chronic pulmonary in- 
flammation, 493 

Dry cupping over back, when due to car- 
diac or pulmonary trouble, 493 

Hyoscine, contraindicated. 493 

Morphine, gr. \ to \ (0.008-0.016), night 
and morning, often cures, when due to 
nervous or cardiac disorders. 492 

Opium, if due to nervous disorders. 492 

Strychnine, in idiopathic types and when 
due to bronchorrhcea in old people, 492 

Thoracentesis, if there is pleural effusion, 
493 

EARACHE, 493 
Cardiac sedatives, 493 



Chloroform, on swab, behind and in front 
of ear in otalgia, 494 

Cocaine, gtt. 1 to 3 (0.5-0.15), dropped into 
nostril, followed by spray if mucous 
membrane is engorged, 493 

Heat, dry, applied to head on affected side, 
493 

Inflation of Eustachian tube with Politzer's 
air-bag, 494 

Leeching behind ear, to relieve pain, 493 

Menthol and albolene spray, following co- 
caine, 492 

Poultices, oil, and laudanum, contraindi- 
cated, 493 

Puncture of tympanum, if it bulge, fol- 
lowed by careful cleansing and insuffla- 
tion of boric acid, 494 

Saline solution, in tine spray, if cold in 
head is present, 493 

Water, hot as can be borne, dropped into 
ear gives great relief, 493 

EAR (DISEASES OF). 

Glycerin, useful to soften impacted ceru- 
men, 197 

Potassium permanganate, solution, useful 
in otitis media, 291 

ECLAMPSIA, 620 
! Chloral and bromide, each 1 drachm (4.0), 

by rectum, before applving hot pack, 

621 
Chloroform, pushed rapidly as possible, at 

onset of attack, 621 
Elaterium, gr. \ (0.016), rubbed up with 

butter, or compound jalap powder and 

calomel, may be substituted for croton 

oil. 621 
Ether, as an anaesthetic, contraindicated, 

621 
Extraction of child rapidly as possible, if 

attack comes on during labor, 621 
Ice-bag to head while in warm pack, 621 
Morphine, veratrum viride, and amyl ni- 
trite, may be held in reserve, to be used 

if necessary, 621 
Pilocarpine, contraindicated, 621 
Venesection, hot wet pack, and croton oil, 

gtt. 2 (0.1), with sweet oil on tongue, to 

eliminate poison, 620 
Veratrum viride in full doses, 355 

ECZEMA, 494 

Arsenic, only when skin is very dry, 496 

Bismuth subgallate in weeping eczema, 92 

Calamine in moist eczema, 123 

Cantharis, internally in small doses, 115 

Carbolic-acid ointment (minims 10 [0.65] to 
cerate 1 ounce [32.0]), to prevent itch- 
ing, 120, 494 

Dermatol in weeping eczema, 92 

Green soap, 327 

Hygienic measures and diet, 494 

Ice-water injections, highly recommended 
in eczema of anal margin, 373 

Ichthvol ointment, highly recommended, 
211 

Internal treatment, 496 

Iron, syrup of iodide, in young children 
with anaemia and debility, 227 

Kaolin as a dusting-powder, 232 



716 



INDEX OF DISEASES AND REMEDIES. 



Lead, dilute solution of subacetate, a useful 

lotion, 237 
Liquor carbonas detergens, in acute cases, 

495 
McCall Anderson's ointment, 494 
Ointments, prescriptions for, 284, 309, 495 
Poultices, or olive oil with carbolic acid 
(gtt. 1 to 2 to the ounce [0.05-0.1 : 32.0] ), 
followed by soap and water, necessary 
in some cases to soften scales, before use 
of ointment, 495 
Prescription for, 296 
Prescription of iodol, as an ointment, about 

nose and lip, 221 
Eesorcin ointment (gr. 2 to 30 to the ounce 
[0.1-2.0:32.0]), locally applied in sub- 
acute types ; in chronic form, ointment 
(gr. 2 to 10 to the ounce [0.1-0.65 : 32.0]), 
495, 496 
Salicylic-acid ointment (gr. 30 to 60 [2.0- 
4.0] to lard 1 ounce [32.0]), in chronic 
or weeping types, 496 
Starch poultice in crusty eczema, 333 
Sulphides, bath of, often beneficial, 337 
Tar ointment, in chronic forms, 496 
Thiol, as a dusting-powder, preceded by an 
antiseptic wash, especially suited to 
moist eczema, 347 
Zinc carbonate, as a protective powder in 

weeping eczema, 123 
Zinc oxide, as a dusting-powder or oint- 
ment in early stages, applied directly 
or on lint, generally preceded by black 
wash, 494 

EMISSIONS, 496 
Bromide of sodium or potassium, gr. 20 

(1.3), at bedtime, valuable in spinal irri- 
tability, 497 
Chloral, gr. 20 (1.3), at bedtime, 497 
Cold douches to perineum and scrotum, 

497 
Hygienic measures, 497 
Hvoscine, gr. T £- ff (0.0006), of great value, 

497 
Potassium citrate, gr. 20 (1.3), thrice daily, 

to render urine non-irritating, 497 
Strychnine and arsenic, in full dose, of 

great service in genital atony, 497 
Warm bath before retiring, often useful, 

497 

EMPHYSEMA OF LUNGS. 

Cod-liver oil, useful, 161 

Ethyl iodide, 188 

Euphorbia pilulifera, | to 1 drachm (2.0- 

4.0) of the fluid extract, 190 
Iodide of potassium, 213 
Physostigma, aids in expelling mucus, 298 
Strychnine, 275 

EMPYEMA. 

Iodine, gr. 6 (0.4) ; potassium iodide, gr. 6 
(0.4) ; water, 1 pint (500 cc), as an irri- 
gating fluid, used daily, 217 

ENDOCARDITIS, 498 
Aconite, tincture of, gtt. 2 to 3 (0.1-0.15), 

hourly, in early stage of acute sthenic 

types, 498 
Antirheumatics, antilithics, or iodides, if 

due to diathetic taint, 498 



Calomel, gr. \ (0.016), with morphine, gr. 

-■h (0.006), every two hours, in early 

stages, 498 
Digitalis, to strengthen heart in later stages, 

498 
Ice-bag over prsecordium, 498 
Iron, tincture of chloride, associated with 

supportive treatment, in purulent types. 

498 
Leeches or wet cups, in early stages, to 

abort, 498 
Lithium citrate or acetate^ or citrate of po- 
tassium, to prevent calcareous deposit 

in valves, 498 
Mercury, in full dose, in sthenic cases, 250 
Veratrum viride, used for same purposes 

as aconite, 498 

ENTERITIS. (See Dysentery and 
Diarrhoea.) 

EPIDIDYMITIS, 533 

Heat, moisture, and pressure, in later 
stages, to relieve induration, 534 

Horand-Langlebert's dressing, 534 

Ice-bags, 534 

Iodide of potassium, gr. 10 to 20 (0.65-1.3), 
thrice daily, to remove induration, 534 

Iodine, painted over scrotum, said to be 
beneficial, 534 

Mercury and belladonna ointments, equal 
parts, or iodine, gr. 4 (0.25), with lano- 
lin, ounce 1 (32.0), locally applied, to 
relieve induration, 534 

Punctures, useful to relieve tension and al- 
leviate pain, 534 

Eest in bed. elevation of pelvis and testi- 
cles, cessation of local gonorrhceal treat- 
ment, and administering treatment for 
acute inflammation, 534 

Silver nitrate, solution, painted over scro- 
tum, in early stage, may relieve, 534 

Strapping and suspending testicle, to re- 
duce inflammation, 534 

EPILEPSY, 498 

Acetanilid, 43 

Ammonium or sodium nitrite, used to sup- 
plement amyl nitrite, 506 

Amyl nitrite, inhalations, when aura is per- 
ceived and also in status epilepticus to 
relax spasm, 505, 506 

Anaesthetics contraindicated in all cases ex- 
cept status epilepticus, when chloroform 
may be used to control attack, 506 

Antifebrin and antipyrine, especially use- 
ful in chronic cases when bromides fail, 
507 

Belladonna, with bromides, recommended, 
503 

Bleeding, harmful, except in marked cere- 
bral congestion or for the status epilep- 
ticus, 506, 508 

Brornate of potassium, 503 

Bromide of ammonium, should be used 
with other drugs, 502 
calcium. 99 
gold, 99 

iron, when ansemia is present, 502 
lithium, highly recommended in some 

cases, 502 
nickel, 502 



INDEX OF DISEASES AND REMEDIES. 



717 



Bromide of potassium, the most reliable, in 
ascending dose, 500 

sodium, not so apt to disorder stomach, 
502 
Cannabis indica, 504 

Chloral, alone or with bromides, well di- 
luted, after meals, used with care, 506 
Diet, 508 
Digitalis, with bromides, useful in some 

cases, 503 
Gelsemium, Avith cannabis indica, often of 

value, 504 
Hydrobromic acid, liable to derange diges- 
tion, 503 
Iodide of potassium, useless except in 

syphilitics, 506 
Mercury, instead of potassium iodide, when 

due to gumma, 506 
Mixed treatment, 500 
Monobromated camphor, 111 
Nitro-glycerin, useful in some cases of petit 

mal, 505 
Opium with gelsemium, only to be used 

when other remedies fail, 504 
Potassium nitrite, 268 
Quassia injections, when due to worms; if 

not obtainable, sodium cbloride solution 

may be used, 507 
Quinine and salicylic acid, contraindicated, 

508 
Silver nitrate, may be tried when other 

remedies fail, 505 
Solanum carolinense, fluid extract of, 2 to 

15 minims (0.1-1 cc), thrice daily, in 

the epilepsy of childhood, 507 
Strontium bromide, 334 
Strychnine, contraindicated, except in rare 

cases, 508 
Zinc salts, seldom used of late, 504 

EPISTAXIS, 509 

Acetanilid has been recommended, 43 

Acetic acid, locally applied, to arrest, 44 

Aconite or veratrum viride, tincture, gtt. 2 
to 4 (0.1-0.2), in sthenic cases, followed 
in thirty minutes by smaller doses, if 
necessary, 47, 509 

Alum powder, pure or half-and-half with 
starch, as a snuff, 509 

Bacon fat inserted as a plug in nostril, may 
arrest, 509 

Compression of facial artery may be neces- 
sary, 509 

Ergot, turpentine, hamamelis, or oil of erig- 
eron, internally, in slow oozing, 509 

Hot foot-bath, or hot- or cold-water bags 
applied to dorsal vertebra?, may arrest, 
510 

Ice applied to nose, may arrest, 510 

Ipecac, in nauseating doses, recommended, 
509 

Monsel's solution, in spray (gtt. 30 to 4 
ounces [2.0-123.0]), only to be tried 
when other remedies fail ; very disagree- 
able, 509 

Plugging anterior and posterior nares, if 
necessary, with cotton or lint soaked in 
vinegar. 509 

Tannic acid, in powder or solution, snuffed 
up nostril, 509 

Vinegar or lemon-juice injected into nos- 
tril, 509 



EPITHELIOMA. 

Acid nitrate of mercury, applied to part 

with glass rod, 256 
Arsenous acid and gum acacia (of each 1 

ounce [32.0], to water 5 fluidrachms 

[20.0] ), locally applied, 79 

ERYSIPELAS, 510 

Alcoholic stimulants if patient passes into 
typhoid state, 510 

Antipyrine, to control fever, 510 

Belladonna, tincture, internally, minims 4 
to 5 (0.2-0.25), every four hours, and lo- 
cally applied on lint or ointment smeared 
over part, 510 

Bitters and iron, during convalescence, as 
tonics, 510 

Boric acid, as a lotion, 93 

Ichthyol ointment and vaseline, half and 
half, locally applied, preceded by wash- 
ing with castile soap, followed by bi- 
chloride solution (1 . 1000), 511 

Iodine, tincture, painted around inflamed 
edges, to arrest, 217 

Iron, tincture of chloride, gtt 20 to 40 
(1.3-2.6), thrice daily, best internal 
treatment, 510 

Pilocarpine, gr. J to I (0.003-0.01), hypo- 
dermically, contraindicated in debility ; 
also injected around borders of inflam- 
mation in some cases, to arrest, 510 

Silver nitrate, solution (gr. 80 to the \ 
ounce [5.0 : 16.0] ), applied twice or 
thrice, to arrest, 511 

Veratrum viride or aconite, in early stages 
of sthenic cases, 510 

White-lead paint, locally applied, when 
ichthyol is not at hand, 511 

EXHAUSTION AND DEPRESSION. 

Stimulants, 511 

EXOPHTHALMIC GOITRE. 

Belladonna relieves some cases, 83 
Sparteine, 323 

EYELID (ECCHYMOSIS OF). 

Alum, curd or solution, to prevent discol- 
oration, 57 

FAINTING. 
Alcohol, 50 

FEET (SWOLLEN, TENDER, OR 
SWEATING), 511 

Arsenic, gr. ^ to -^ (0.001-0.0015), in swell- 
ing of old persons, 512 

Borax, stockings soaked in saturated solu- 
tion and dried, each day, when sweat- 
ing is excessive, 512 

Carbonate of calcium, precipitated, locally 
applied to sweating feet, 105 

Cotton, instead of woollen stockings, may 
aid cure, 512 

Hamamelis, distilled, or fluid extract, 
drachm i to 1 (2.0-4.0) of former, or 
gtt. 10 to "20 (0.65-1.3) of latter, 512 

Lead plaster and linseed oil, equal parts, 
applied on linen to feet, every third day, 
for sweating, 237 

Prescription for dusting-powder, 512 

Best, absolute, of feet, may be necessary in 
swollen feet, 512 



718 



INDEX OF DISEASES AND REMEDIES. 



Salicylic acid and borax, equal parts, in 
water and glycerin, best application to 
sweating and tender feet, 512 

FELON. 

Bread-crumbs saturated witb liquor plumbi 
subacetatis, as a poultice, to abort, 237 

Silver nitrate, solution, applied early, to 
abort, 265 

FEVER, 512 

Acetanilid, 42 

Aconite, tbe best depressant for sthenic 
types in children, 47 

Alcohol, as a systemic support and stimu- 
lant in low fevers, 50 

Antipyretics, useful in most sthenic fevers, 
often fail in thermic fever, 516, 517 

Antipyrine, 72 

Brand's method, 656 

Cold applications and baths, 516 

Cold packs and baths, in asthenic types, to 
be relied on first ; if impracticable, 
then antipyretics, 517 

Digitalis, in small dose, valuable in ex- 
hausting fevers, 177 

Musk, by rectal injections, valuable in low 
stages, 261 

Neutral mixture, useful as a febrifuge, es- 
pecially in children. 155 

Pheuacetin, 292 

FIBROIDS. 

Ergot, used as an expulsive and curative 
remedy, 181 

FLATULENCE. 

Aromatic powder, 154 

Asafoetida, 81 

Camphor, 109 

Capsicum, prevents formation of gas, 116 

Chloroform, gtt. 1 to 2 (0.05-0.1), or spirit, 

gtt. 10 to 20 (0.65-1.3), will relieve, 145 
Cloves, a useful tonic and stimulant, 156 
Hoffmann's anodvne, the best carminative, 

202 
Pepper, 288 
Peppermint, 288 
Potassium permanganate, 291 
Turpentine, prescriptions for, 351 

FRECKLES AND CHLOASMA, 518 

Almonds, emulsion of, supposed to be of 

value, 54 
Boric acid, saturated solution, applied same 

as corrosive sublimate wash, 518 
Corrosive sublimate (gr. 1 to 4 to the ounce 

[0.05-0.25:32.0]), applied night and 

morning until irritation appears, then 

stop for some days and again renew, 

518 
Lactic acid (gr. 10 to the drachm [0.65 : 4.0]) 

applied same as corrosive sublimate, 518 
Prescription for chloasma of pregnancy, 

284 
Prescriptions for. 518 

FURUNCLES. (See Boils.) 

GALACTORRHCEA, 618 
Antipyrine, gr. 2h (0.125), thrice daily, said 
to decrease secretion, 619 



Caustic, introduced into uterus, successful 
in some cases by inducing menstrual 
flow, 619 

Chloral should be tried, 619 

Compression of gland with applications of 
belladonna ointment and potassium 
iodide internallv, usually relieves, 619 

Diet, 619 

Electricity, generally ineffective, 619 

Ergot, long continued, highly recom- 
mended, 619 

Malt, wine-glassful at midday and evening 
meals, useful addition to diet ; pyro- 
phosphate of iron, gr. 5 (0.3), in addi- 
tion, if anaemia is present, 619 

Warm douches, 619 

GANGRENE. 

Bromine, as an escharotic in hospital gan- 
grene, 100 

Carbolic acid or creosote, spray fgtt. 5 to 10 
to the ounce [0.3-0.65 : 32.0]), useful in 
pulmonary gangrene, 120 

Nitric acid, to destroy tissue, 267 

GASTRALGIA, 518 

Acetanilid, 42 

Alum. 58 

Arsenic with iron, the most reliable rem- 
edy, prescription for, 519 

Bismuth and pepsin. 1 to l£ hours after 
meiils. to prevent pain, 519 

Bromide of strontium, a valuable new rem- 
edy. 519 

Bromides or valerian, alternated with other 
treatment if case is neurotic, 519 

Cannabis indica, prescription for, 113 

Cod-liver oil in emulsion with hypophos- 
phites, occasionally better tban arsenic 
and iron, 519 

Counter-irritation and a vigorous revulsive, 
especiallv useful in hysteria, 519 

Cyanide of 'potassium, dilute hydrocyanic 
acid or chloroform as a substitute for 
bismuth, if it favors constipation, 519 

Diet and hygiene, 519 

Emesis and purgation, when due to indi- 
gestible food, 519 

Hot applications, stimulating infusions, hot 
brandy or whiskey or laudanum, gtt. 30 
(2.0) to 60 (4.0), during acute stage, 519 

Hydrocyanic acid, useful in nervous types. 
* 206 

Massage, enemata. diet, or suppositories of 
gluten, glycerin, or soap, to overcome 
constipation, 519 

Menthol, 289 

Nitro-glycerin, 268 

Potassium nitrite, gr. 4 to 5, 268 

Salicylic acid, used in paroxysmal forms. 
315 

GASTRIC CATARRH (ACUTE), 520 
Ammonium muriate, useful in subacute 

forms in children, prescription for, 63 
Diet, principal point in treatment. 520 
Effervescing draughts, useful in convales- 
cence. 520 
Emetic, mild, to dislodge fermenting mass, 

if present, 520 
Ice, to quench thirst, if anorexia is great, 
520 



INDEX OF DISEASES AND REMEDIES. 



719 



Iron, if anaemia exists, 520 

Milk, with large percentage of lime-water, 

520 
Pepsin and hydrochloric acid, 521 
Salicylic acid, valuable in vomiting, 315 
Salt, in moderation with food, 521 
Seidlitz powder, one-fourth of one powder 

every fifteen minutes, to settle stomach 

and remove fermenting mucus, 520 
Sodium bicarbonate with gentian, useful in 

convalescence and in children, 520 
Spice poultice to relieve epigastric distress, 

520 
Tartar emetic, given early, in acute attack 

of children, may abort, 69 

GASTRIC CATARRH (CHRONIC), 519 

Apomorphine, as an emetic, to throw off" 
mucus, 75 

Bismuth subnitrate, added to prescription, 
if hyperacidity exists. 519 

Cascara sagrada, if constipation exists, 519 

Charcoal, prescription for, 121 

Diet, such as koumyss, light broths, and 
matzoon, 519 

Silver nitrate and hyoscyamus, with coun- 
ter-irritation and regulated diet, 520 

GASTRIC DILATATION, 522 

Cod-liver oil, by stomach or inunction, if 
due to rhachitis, 52 

Diet, 522 

Enemas, nutrient, often useful, especially 
in older children, 523 

Faradization of gastric walls recently in- 
troduced. 523 

Gentian and calumba, useful as tonics, 523 

Iodide of iron, syrup of, lacto-phosphates 
of lime, or phosphate of sodium, in stru- 
mous diathesis, 522 

Lavage. 522 

Phvsostigma. tincture, gtt. 5 to 10 (0.3-0.65), 
or extract, gr. £ to £ (0.008-0.016), to im- 
prove muscular coats, 523 

GASTRIC ULCER, 523 

Bismuth and sodium bicarbonate, as an as- 
tringent and sedative, and to these may 
be added morphine or codeine for pain, 
524 

Carlsbad salts, magnesium sulphate, or so- 
dium phosphate, for relief of constipa- 
tion, 525 

Cocaine, gr. J, alone or combined with bis- 
muth, to control vomiting. 525 

Counter-irritation, mild, continuous, over 
belly, to relieve pain, 524 

Creosote or carbolic acid, for vomiting, 525 

Diet and hygiene. 524 

Monsel's solution, cold compresses, or tur- 
pentine, may be given to check hsernat- 
emesis. 525 

Prescription for, 483 

Morphine for pain or collapse following 
perforation, 525 

Bectal alimentation, of great service, 524 

Resorcin useful in some cases. 309 

Silver nitrate with hyoscyamus in pill, half 
to one hour before meals, 524 

Spice plaster, useful as a mild continuous 
counter-irritant, 524 



Stimulants, cardiac, guardedly adminis- 
tered, external heat and rubbing, in col- 
lapse following hemorrhage or perfora- 
tion, 525 

GASTRITIS (ACUTE), 525 

Belladonna, internally, and flaxseed poul- 
tice over epigastrium and chest, if col- 
lapse threatens, 525 

Bismuth, as an astringent and sedative, 91 

Flaxseed tea, a useful demulcent, 191 

Mucilaginous drinks and albuminous sub- 
stances freely given, 525 

Oils, to prevent spread of inflammation, 
525 

Opium, in fluid form, to relieve pain and 
irritation, 525 

Warm water, internally, or stomach-pump, 
to unload stomach at onset, 525 

GASTRO-ENTERITIS, 526 

Castor oil or magnesium sulphate, to sweep 
out poison, 526 

Morphine, hypodermically, to allay pain, 
followed or preceded by mild, rapidly 
acting emetic, if irritating substance re- 
mains, 526 

Opium and sulphuric acid, with hot appli- 
cations or plasters to belly, to control ir- 
ritation and diarrhoea, 526 

GASTRO-INTESTINAL CATARRH. 

Carlsbad, Vichy, or other alkaline mineral 
water of purgative powers, often useful, 
397 

Diet for seven-year-old child, 408 

Garlic, as a poultice to belly almost equal 
to spice poultice, 54 

Hydrastis, especially useful if due to alco- 
holism, 204 

Sanguinaria, of service if jaundice is pres- 
ent, 320 

Sodium bicarbonate, 10 to 20 grains, 90 

Tar, in2-gr. (0.1) pills, 324 

GIDDINESS. 

Cod-liver oil with quinine, valuable in old 

age, 161 
Ergot and bromides useful, 181 

GLANDS (DISEASED). 

Ammoniac plaster, as a stimulant to en- 
larged glands, 61 

Ammonium iodide and glycerin (gr. 30 to 
the ounce [2.0 : 32.0]), locally applied to 
enlarged tonsils, 63 

Carbolic acid (2 per cent, solution), injected 
into glands threatening suppuration, 120 

Carbon bisulphide, in enlarged glands, 122 

Cod-liver oil, in lymphatic enlargements, 
161 

Ichthyol ointment, valuable as an inunc- 
tion in lymphatic enlargements, 211 

Iodine, the best remedy for enlargements, 
216 

Mercury ointment as an inu-nction in en- 
larged glands, 256 

GLAUCOMA, 527 

Atropine, coutraindicated, 527 



720 



INDEX OF DISEASES AND REMEDIES. 



Eserine (gr. 1 to 2 to the ounce [0.05-0.1- 
32.0]), or pilocarpine nitrate (gr. 2 to 4 
to the ounce), dropped into eye if opera- 
tion is delayed, 527 

Hot compresses, leeches, and opiates to re- 
lieve pain, 527 

Iridectomy, the only curative treatment, 
527 

GLEET. 

Bichloride of mercury, injection (gr. \ to 
water ounces 6 [0.025 : 192.0]), every 
three or four hours, 251 

Cantharidal collodion, applied to under 
surface of penis, or perineum, 377 

Cantharides, 115 

Gurjun oil, 200 

Turpentine, internally. 351 

Uva ursi, 352 

GOITRE. (See Bronchocele.) 
GONORRHOEA (ACUTE), 527 

Aconite, gtt. 2 (0.1), every two or three 
hours, if inflammation is high, 529 

Almond emulsion, diminishes burning on 
urination. 54 

Benzoic acid, with cannabis indica, useful 
in later stages, 90 

Bicarbonate of sodium or potassium citrate, 
gr. 10 (0.65), after meals, increasing, if 
necessary; relieves ardor u rinse, 529 

Cannabis indica, often used in later stages 
instead of copaiba and cubebs, 113 

Cinnamon oil, by injection or spray, 154 

Cocaine, solution (4 percent), instilled into 
urethra before urination, diminishes 
ardor urime, 529 

Copaiba, to relieve ardor u rinse and stimu- 
late mucous membrane in later stage, 
168 

Cubebs, useful in later stage, 173 

Diet and hygiene, 530 

Erigeron oil, occasionally used instead of 
copaiba and cubebs, 182 

Eucalyptus, valuable in subacute stages, 
188 

Gurjun oil, of value in place of copaiba and 
cubebs, 200 

Hot sitz-bath, prolonged, and hot-water in- 
jections, useful in females, 535 

Hydrastis, one of the best remedies, locally 
and internally in later stages ; also as a 
vaginal wash for females, 204 

Lead acetate, injection, gr. 1 to 8 to the 
ounce (0.05-0.6 : 32.0), 237 

Lead-water and laudanum, or alcohol and 
water, applied on a cloth to penis, dur- 
ing inflammation, 528 

Mercury bichloride (1 : 20,000 or 1 : 40,000), 
in large quantities to flush urethra : in 
females, 2 pints of solution (1 : 4000), 
thrice daily, to irrigate vagina, 527, 535 

Opium or belladonna, hypodermically or in 
suppository, to control pain in posterior 
urethritis, at same time discontinuing 
active treatment, and observing strict 
hygiene and diet, 530 

Prescription for infusion, 204 

Prescriptions for injection for posterior ure- 
thritis, 531 

Quercus alba, injections, useful in females, 
308 



Salol, cubebs, and copaiba, prescription for. 
529 

Silver nitrate, injections (gr. 2 to 4 to the 
ounce [0.1-0.2 : 32.0]), useful in subacute 
stage ; in females, gr. 4 to 60 to the 
ounce (0.2-4.0 : 32.0), painted over va- 
gina, followed by astringent cotton tam- 
pon, 266, 535 

Urinating with penis in hot water, to re- 
lieve ardor urinse, 529 

Warm baths, lasting one-half to two hours, 
useful in early stage, 530 

White"s prescription for, 528 

Zinc acetate, injection, gr. 1 to 20 to ounce 
(0.05-1.3 : 32.0) of rose-water. 44 

Zinc chloride, injection (gr. 1 to 2 to the 
ounce [0.05-0.1 : 32.0]), occasionally used 
in second stage, 134 

Zinc sulphate, weak solution, as an astrin- 
gent injection, 338 

GONORRHOEA (CHRONIC), 531 

Copper sulphate or silver nitrate, solution 
as an application, after dilatation, to 
focus of inflammation, 531 

Dilatation, if stricture exists, 531 

Prescriptions for. 531 
j Pressure and use of cold, often valuable, 

532 
! Sandalwood oil, to stimulate depraved mu- 
cous membrane, 319 

Silver nitrate, solution, if discharge per- 
sists after dilatation ; also in posterior 
urethritis, 531 

Uva ursi, 352 

GOUT, 535 

Antipyrine, said to have a specific effect. 
73" 

Baths of sulphides, 337 

Blisters, flying, short distance from in- 
flamed joint, every few days, 537 

Chloral, in insomnia, 537 

Chloroform liniment, applied over affected 
part, 146 

Cod-liver oil, 537 

Colchicum, wine of the root, gtt. 20 (1.3), 
increasing by gtt. 1 (0.05) every four 
hours, until symptoms are relieved or 
appear toxic, in acute types, 536 

Collodion, not more than one or two coats : 
also useful with iodine, 536 

Diet, 537 

Fowler's solution, gtt. 3 (0.15) in water, a 
standard remedy in subacute and chronic- 
types. 537 

Iodide of iron, syrup of, and cod-liver oil 
if anaemia is present, 537 

Iodide of potassium, to relieve night pains : 
also with colchicum, in chronic gout. 
536 

Iodine, ointment or tincture, locally ap- 
plied to chronic gouty joints. 53? 

Leeches or venesection, contraindicated, 
536 

Lithium carbonate or citrate (gr. 5 to 10 to 
the ounce [0.3-0.65 : 32.0] h locally ap- 
plied to dissolve deposit around joints, 
537 

Morphine, hypodermically, near painful 
spot to relieve acute pain, 536 



INDEX OF DISEASES AND REMEDIES. 



721 



Peppermint oil, locally applied, 536 

Potassium bromide, the best remedy for in- 
somnia, 537 

Sodium bicarbonate and linseed oil (1 : 9), 
locally applied to joints, 536 

Stimulants, ether hypodermically, opium 
except in brain or kidnej'' disturbances ; 
diuretic and alkaline drinks and coun- 
ter-irritation, in retrocedent gout, 537 

Water, distilled or medicinal, in large 
amounts, 537 

GRANULAR LIDS. (See Conjunctivitis, 
Granular.) 

GRAVES'S DISEASE. (See Exophthal- 
mic Goitre.) 

GRIPING. 

Allspice or ginger, to prevent griping of 
purgatives, 55, 195 

GROWTHS (PATHOLOGICAL). 

Caustic potash or soda, occasionally used, to 

destroy, 127 
Chromic acid, as a caustic, to growths on 

skin or mucous membranes, 146 
Lime, as an escharotic on hairy growths, 

107 

GUMS (DISEASES OF). 

Burnt alum, useful applied to swollen gums, 
58 

Catechu, as a mouth-wash, for spongy gums, 
126 

Cocaine, locally applied, in soreness and 
tenderness of gums, 158 

Iodine, solution (gr. 1 to the ounce [0.05 : 
32.0]), locally applied, followed by rins- 
ing mouth, when gums are retracted, 
217 

Myrrh, tincture, locally applied, to spongy 
or tender gums, 262 

HiEMATEMESIS, 540 

Ergot, hamamelis, or ipecac, in slow bleed- 
ing, 540 

Ice, cracked, swallowed frequently, accom- 
panied by Monsel's solution, gtt. 3 (0.15) 
in a half-tumblerful of water, every 
fifteen minutes, 540 

Iron, tincture of chloride, or turpentine, 
internally, if passive, 540 

Lead acetate with morphine or opium, gr. 
2 to 3 (0.1-0.15), in pill, 540 

Monsel's salt, gr. 2 to 3 (0.1-0.15), in pill, 
540 

Silver nitrate, gr. \ (0.015) in pill, in slow 
bleeding, 540 

Tannic acid, gr. 20 (1.3), to drachm of 
water ; must not be given with Monsel's 
solution, 540 

HEMATURIA, 542 

Alum, gr. 2 to 3 (0.1-0.15) to water, 1 ounce 
(32.0), injected into bladder, if alarming, 
542 

Camphor, gr. 10. to 20 (0.6-1.3), in divided 
doses, in pill, 542 

Cannabis indica, useful in some cases, 542 

Ergot, 542 

Erigeron, 542 

Gallic acid, gr. 20 (1.3), very valuable, 542 
46 



Hamamelis, injected daily into bladder, or 

used internally, 201, 542 
Hyposulphite of sodium, 5 to 15 grs. (0.3- 

1.0), if due to malaria, 543 
Prescription for, 542 
Quinine, if due to malaria, 543 
Ehus aromatica, 310 
Styptic injections, should only be used 

when bleeding is alarming, 542 
Turpentine, 542 

HEMOPTYSIS, 540 

Acetanilid, has been recommended, 43 

Aconite, to prevent pneumonia following, 
contraindicated in exhaustion, 540 

Alum, solution (gr. 20 to the ounce [1.3 : 
32.0]), in fine spray, 58 

Chloral and bromides* to allay nervous ex- 
citement, 540 

Ergot, fluid extract, 1 to \\ drachms (4.0- 
6.0), internally, 539 

Gallic acid, gr. 20 to the ounce (1.3 : 32.0) of 
water, when ergot is not at hand, 539 

Hamamelis, 201 

Ice or dry cup over bleeding spot, 540 

Ipecac, in small doses, very effective, 222 

Morphine, hypodermically, to allay ner- 
vousness, 540 

Tannic acid, Monsel's solution, or alum, 
used in spray, as styptics, prescriptions 
for, 539 

HAY FEVER. 

Arsenic, 79 

Cocaine, with bismuth and morphine, as a 

snuffj 158 
Eesorcin, solution 2 per cent., in spray, 309 
Terpine hydrate, in full dose, 346 

HEADACHE, 545 

Belladonna, valuable in young people, 87 

Caffeine, with antipyrine or sodium bro- 
mide, in nervous headache, 545 

Capsicum plaster, to nape of neck, 117 

Cimicifuga, if due to eye-strain, 148 

Colchicurn, in gouty headache, 546 

Croton chloral, if due to eye-strain or asso- 
ciated with sick stomach, 172 

Cup, to nape of neck, in congestion, 545 

Ergot, if due to congestion, 181 

Eucalyptus, 188 

Gelsemium, if due to nervous troubles or 
eye-strain, 193 

Hydrobromic acid, if due to eye-strain in 
nervous women, 100 

Ice-bag, applied to head, or leeches behind 
ears, in severe cases, 545 

Kola, very useful in elixir or tincture for 
sick and neuralgic headaches, 232 

Liquor magnesii citratis, in sick headache, 
242 

Magnesium carbonate, gr. 5 to 60 (0.3-4.0), 
in sick headache due to gastric aciditv, 
242 

Mustard foot-bath and plaster to nape of 
neck, in congestion, 545 

JSTux vomica, gtt. 1 (0.05) every five or ten 
minutes till 10 drops (0.65) are taken, in 
sick headache, 275 

Oxygen-water, 285 

Phenacetin, if due to eye-strain or neural- 
gia, 293 



722 



INDEX OF DISEASES AND REMEDIES. 



Potassium bromide, 96 

Prescriptions for, 546 

Salicylic acid or iodide or acetate of potas- 
sium, if due to gout, 546 

Sodium bicarbonate, as an antacid in sick 
beadacbe, 90 

Strycbnine or nux vomica, in sick head- 
acbes or if due to eye-strain, 275, 545 

HEART DISEASE, 546 

Aconite or veratrum viride, often useful in 
palpitation and bypertropby, 550 

Adonidine, often of service when digitalis 
fails, 48, 549 

Ammonia and ether, followed by digitalis 
and alcohol, in heart failure, 550 

Amyl nitrite, in single whiffs, often relieves 
cardiac failure, 65 

Barium chloride, in heart failure, 84 

Belladonna, when arhythmia is present, 
550 

Cactus grandiflorus, useful in valvular dis- 
ease with incompetency, cardiac weak- 
ness and palpitation, 56, 103 

Camphor, in palpitation, 109 

Cimicifuga, as a tonic in fatty and irritable 
heart when digitalis fails, 148 

Convallaria majalis, in cardiac arhythmia, 
167 

Diet and exercise, in fatty degeneration, 
when fat is deposited between muscular 
fibres, 551 

Digestive remedies, in palpitation due to 
indigestion, 550 

Digitalis, to be tried in all heart troubles, 
except in simple or compensatory hyper- 
trophy, 547 

Hoffmann's anodyne, very useful in palpi- 
tation due to indigestion or tobacco, 202 

Iron, in palpitation due to anaemia, 550 

Kola, useful in cases with debility, 232 

Nux vomica, in palpitation, as a stimulant, 
550 

Opium, if dyspnoea prevents sleep, 281 

Sparteine, in arrhythmia or palpitation, also 
as a substitute for digitalis, if it fails, 
549 

Strophanthus, if digitalis fails, 549 

Veratrine ointment, locally in palpitation, 
549 

HEMORRHAGE, 537 

Alum, a useful styptic, applied to bleeding 
vessel, 57 

Arnica, 76 

Compress, soaked in antiseptic liquid or 
filled with antiseptic powder, preferable 
to styptics, 538 

Hypodermoclysis, 390 

Ligation preferable to styptics, when appli- 
cable, 538 

Oil of erigeron, 182 

Packing of astringents, if bleeding point 
cannot be reached by compression, or for 
ligation, 538 

Tannic acid, 344 

Transfusion, 392 

HEMORRHAGE, INTESTINAL, 541. (See 

also Hemorrhage.) 
Enemas, styptic, for hemorrhage from rec- 



tum or colon ; alum (gr. 10 to the ounce 
[0.65 : 32.0]), copper (gr. 5 to the ounce 
[0.3 : 32.0]), Monsel's solution (dr. 1 to 
2 ounces [4.0 : 64.0]), Monsel's salt (gr. 
10 to the ounce, or drachm i [2.0] to 
water 2 ounces [64.0]), chlorate of pot- 
ash (gr. 10 to 25 to the ounce [0.6-1.0 : 
32.0]), and tannic acid (gr. 20 to ounce 
[1.3 : 32.0] of glvcerin and water), 541 

Ergot, 541 

Ice, by mouth, and Monsel's salt, gr. 3 (0.15), 
in hard pill, everv half-hour or oftener, 
541 

Ice- water injections in bloody purging of 
dysentery, 542 

Lead acetate and camphor, in pill, of ser- 
vice in some cases, 541 

Monsel's solution not advisable, 228 

Sulphuric acid, gtt. 5 to 10 (0.3-0.65) in 
water, 541 

Tannic acid, in solution or pill, when Mon- 
sel's salt is not at hand, 541 

Turpentine, in capsule or emulsion, when 
bleeding is not active, 541 

HEMORRHOIDS, 543 

Aloes, 543 

Carbolic or acetic acid, locally applied, 544 

Carlsbad salts, taken before breakfast to 
cause evacuation, 544 

Cold-water injections in the morning, re- 
lieve congestion and cause easy evacua- 
tion, 544 

Ergot, sometimes useful in bleeding piles, 
181 

Gallic acid and ointment of stramonium, 
equal parts, 192 

Gallic acid and opium, ointment, prescrip- 
tion for, 543 

Hamamelis, internally or as a lotion or in- 
jection, 544 

Iodoform suppository, if ulceration is pres- 
ent, 221 

Nitric acid, lightly touched to one or two 
points, 267, 544 

Prescription for, 544 

Potassium chlorate, with laudanum, as an 
injection, 134 

Poultice, to effect reduction, 544 

Quercus alba, as an astringent wash, 308 

Bhubarb-root, gr. 10 to 20 (0.6-1.3), chewed 
before retiring, to relieve constipation, 
544 

Stillingia, prescription for, 333 

Sulphur, to produce soft passages, 339 

Tannic acid, suppositories in bleeding piles, 
344 

HEPATIC ABSCESS, 552 

Active treatment for dysentery, if present, 

553 
Ammonium muriate, thought to be of 

value, 63 
Aspiration, when pus forms, 552 
Diet, 553 
Quinine, after abscess develops, 553 

HEPATIC CIRRHOSIS. 

Ammonium chloride, 63 

Iodoform, highly recommended, 220 



INDEX OF DISEASES AND REMEDIES. 



723 



Nitro-niuriatic acid, in early stages, 270 
Potassium iodide, often useful in early- 
stages, 213 

HEPATITIS (ACUTE), 552 

Aconite, in early stages, 552 

Cantharidal blister, small, over right hypo- 
chondrium ; if impracticable, use mus- 
tard plaster, 552 

Hot cloths, over counter-irritant, may re- 
lieve pain and aid in formation of blis- 
ter, 552 

Saline purgatives, preceded by calomel, gr. 
1 (0.05), in divided doses, if constipation 
exists, 552 

Sweet spirit of nitre with potassium citrate, 
or diuretic waters, to regulate kidneys, 
552 

Veratrum viride, rarely used, 552 

HEPATITIS (CHRONIC AND SUBACUTE), 
553 

Ammonium chloride, useful in subacute 
forms, 63 

Antisyphilitic treatment, if due to syph- 
ilis, 553 

Aspiration, frequently repeated, may effect 
a cure, 553 

Nitro-muriatic acid, internally and exter- 
nally, most useful remedy, 553 

Potassium iodide, useful in all cases, 553 

HERNIA. 

Chloroform, inhalations, to relax muscles 
during reduction, 145 

HICCOUGH, 554 

Belladonna, 87 

Camphor, spirit of, dose 1 drachm, 554 

Capsicum, tincture, gtt. 2 to 3 (0.1-0.15), 554 

Chloral, 131 

Chloroform, 554 

Ether, inhaled or sprayed on epigastrium 

554 
Hoffmann's anodyne, especially valuable 

554 
Musk, gr. 10 (0.65), given by rectum, valu 

able in all cases, especially in typhoid 

fever, 554 
Nux vomica, accompanied by mineral acids, 

if due to indigestion, 554 
Oil of amber, gtt. 5 to 10 (0.3-0.65), in cap 

sule, one of the best remedies, 58, 554 
Pilocarpine hydrochlorate, hypodermically 

if due to uraemia, 554 
Valerian, tincture of, dose 1 drachm (4.0) 

554 

HOARSENESS. 
Sulphides or sulphur-water, if due to cold 

or speaking, 337 

HYDROCELE. 

Iodine, injections, after evacuation of the 
sac, the best curative remedy, 217 

HYDROCEPHALUS. 

Potassium iodide, to cause absorption of 
fluids, 213 

HYSTERIA. 

Calcium bromide, 99 



Hops, as a nervous sedative, 203 
Monobromated camphor, to produce sleep, 

111 
Oil of amber, 58 
"Pill of three valerianates," recommended, 

353 
Potassium bromide, 96 
Valerian, 352 
Valerianate of ammonium,. 63 

IMPOTENCE. 

Cannabis indica, with strychnine, nmx 

vomica, or ergot, if no organic trouble 

exists, 113 
Cantharis, with nux vomica and iron, may 

restore sexual power if loss is due to 

excess, 115 
Cold douche to perineum and testicles, in 

atonic types, 374 
Gold, chloride of, and sodium, gr. -fa (0.003), 

197 

INCONTINENCE OF URINE, 554 

Antiseptic fluids, to cleanse bladder, in 
paralysis, 556 

Arsenic, with nux vomica, in weakness of 
spinal centres, prescription for, 555 

Belladonna, if due to vesical spasm, 555 

Buchu, with sweet spirit of nitre, valuable 
in some cases, 102 

Cantharides, gtt. 1 (0.05), with alkaline 
diuretics, thrice daily, in adults, 114, 
556 

Catheterization, in retention or paralysis, 
556 

Circumcision, if prepuce is redundant, re- 
lieves some cases, 555 

Diuretic waters, used for years, necessary 
in some cases, 556 

Fowler's solution, gtt. £ to 1 (0.025-0.05), 
in chronic types due to atony, 555 

Hyoscyamus, if due to irritable bladder, 
209 

Rhus aromatica, in incontinence of chil- 
dren, due to atony, 310 

Santonin, often valuable when other rem- 
edies fail, 320 

Sweet spirit of nitre and potassium citrate, 
if urine is dark and concentrated, pre- 
scription for, 555 

INDIGESTION GASTRIC (AND INTES- 
TINAL), 556 

Alcohol, in adynamic types, 556 

Alkalies, before meals in atonic states, dur- 
ing or after meals when the secretion of 
acid is excessive, 557, 558 

Ammonium chloride, in painful forms, 63 

Asafcetida, in indigestion of old age, asso- 
ciated with flatulence, 82, 560 

Bitter tonics, useful in atony, contraindi- 
cated in gastric irritation, 557 

Bromide of strontium, in excessive secre- 
tion, when not due to ulcer, 559 

Chloroform, gtt. xx (1.3), often of great 
value, 561 

Chloral, creosote, sodium hyposulphite, or 
thymol, with lavage, when fermentation 
is excessive, 559 

Diet, 557 
1 Fats, excluded in fermentative types, 559 



724 



INDEX OF DISEASES AND REMEDIES. 



Gold, chloride of, and sodium, when epi- 
gastric pain is present, 197 

Hydrochloric acid, combined with carda- 
moms, in atrophy of the gastric tubules, 
cancer, or intestinal dyspepsia, 205, 558 

Hyoscyamus, belladonna, opium, bromides, 
and bismuth, where there is hyperacid- 
ity, 558 

Leptandra, of great value in intestinal 
types, prescription for, 238 

Nitrate of silver, especially where an ulcer 
is present, 559 

jSTitro-hydrochloric acid or nitric acid, val- 
uable in many cases, 270, 560 

Pancreatin, with sodium bicarbonate and 
alkaline mineral waters in intestinal 
types, 560 

Podophyllin or mercury in lientery, 560 

Prescription for torpid liver of indigestion, 
561 

Prescription for flatulence of intestinal in- 
digestion, 560 

Serpentaria, as a tonic, 386 

Strychnine, quinine, and nux vomica, use- 
ful tonics, 557 

Yellow oxide of mercury, gr. fa or fa, in 
trituration, if there is foul belching or 
ill-smelling stools, 257 

INFLAMMATION. 

Cannabis indica, valuable in chronic types, 
112 

Cocaine, in acute types, prescription for, 
157 

Hop poultice, 203 

Liquor plumbi subacetatis, useful as a top- 
ical application, 236 

Opium, 280 

Veratrum viride, 355 

INFLUENZA, 561 

Aconite, sweet spirit of nitre, and citrate 
of potassium in combination, valuable 
in early stage, 562 

Antipyrine, phenacetin, and acetanilid 
should only be used in small dose to 
allay pain, 561 

Belladonna, combined with strychnine, if 
there be vasomotor paresis, 565 

Bromides, if cough be excessive, 565 

Cannabis indica, often valuable if pushed, 
for irritative cough, 565 

Chloral, chloralamid, or sulphonal, for in- 
somnia, 565 

Cold bath, preferable to antipyretics for re- 
duction of temperature, 562 

Cup, contraindicated, 563 

Ergot, cannabis indica, with bromides, often 
relieve vertigo, 565 

Salol and phenacetin, valuable in combi- 
nation, to allay irritation and pain, 562 

Sandalwood oil, for excessive cough, 319 

Steam inhalations, laden with vaporized 
drugs, for cough, 564 

Strychnine, preferable to digitalis if there 
be tendency to collapse, 563 

INSANITY. (See Mania, Acute.) 

INSOMNIA, 566 
Amylene hydrate, useless if due to pain, 
567 



Bath, cold, in cerebral anaemia, hot in ner- 
vous irritability, 371 

Bromide of potassium with Fowler's solu- 
tion, in nervous females, prescription 
for, 566 

Cannabis indica, prescription for, 113 

Chloral, useful if not due to pain, prescrip- 
tion for, 566 

Chloralamide, gr. 15 to 60 (1.0-4.0), in wine 
or capsule, in nervous insomnia, 567 

Chloralose, 2 to 7 grains (0.1-0.5), in cap- 
sule, 132 

Croton chloral, preferable to chloral, if due 
to pain, 172 

Duboisine more useful than hyoscine, 178 

Hop pillow, 203 

Hot- water bags to feet and cold to head, if 
due to cerebral hyperemia, 567 

Hyoscine, gr. T fo to fa (0.0006-0.0008), by 
mouth, or gr. T ^ to T &<y (0.0004-0.0006), 
hypodermically, in mania or hysteria, 
566 

Hypnal, useful in insomnia due to pain, 
210, 567 

Morphine with chloral, if due to pain, pre- 
scription for, 566 

Opium, only to be used in pain, 279 

Paraldehyde, 287, 567 

Potassium bromide, in nervousness and 
overwork, 97 

Somnal, minims 10 to 40, in liquorice and 
water, 567 

Sulphonal, prescription for, may be given 
in hot water, 567 

Tetronal, useful, 349 

Trional, in 15-grain (1.0) doses, 349 

Valerian, in nervousness, 352 

INTERMITTENT FEVER, 567 

Alcohol, contraindicated, during chill, 569 

Anesthetization, has been employed to put 
ofl' paroxysm, 569 

Antipyrine, if fever is excessive, 569 

Arsenic, in intervals between attacks, as 
an antiperiodic, 568 

Calomel, gr. £ to \ (0.011-0.01), every fif- 
teen minutes until 1 grain is taken, 
four or five hours before quinine, if con- 
stipation is present, 568 

Chloroform inhalations, preceded by lauda- 
num, by mouth or rectum, or morphine, 
gr. £, with atropine, gr. fa (0.001), hypo- 
dermically, if death threatens during 
chill, 569 

Cool drinks and sponging, in fevered stage, 
569 

Digitalis, to relieve internal congestion 
during chill, 568 

Ice-pack, if fever is long continued and ex- 
cessive, 569 

Ipecac or zinc sulphate, as an emetic, if 
chill follows full meal, 568 

Methylene blue, 1 to 4 grains (0.05-0.2), 
259 

Phenocoll, sometimes useful, 294 

Podophyllin, gr. fa to J (0.006-0.007), pre- 
ceding quinine, if constipation is pres- 
ent, 568 

Potassium or sodium nitrite, gr. 10 (0.65), 
have been employed to put off attack, 
569 



INDEX OF DISEASES AND REMEDIES. 



725 



Quinine, as a prophylactic and antiperiodic, 

568 

INTESTINAL CATARRH. 

Ammonium chloride, useful in subacute 

types, 63 
Chlorate of potassium, injections (gr. 20 to 

the ounce [1.3 : 32.0]), in acute rectal 

catarrh, 134 
Iodide of potassium, if ammonium chloride 

fails to relieve, 213 
Leptandra, fluid extract, dose 20 minims to 

1 drachm (1.3-4.0), 238 
Salol, 318 

INVOLUTION (ANOMALIES OF), 615 

Cannabis indica, of great value in subinvo- 
lution, 113 

Curette, in subinvolution due to retention 
of hypertrophic endometrium, 616 

Digitalis, in subinvolution due to sluggish 
circulation, 616 

Ergot, quinine, and strychnine, in pill, if 
due to fibroids, 615 

Purgatives, disinfectants, and possibly hot 
water locally applied, if due to inflam- 
mation, 616 

Eemoval of placenta, if adherent, 616 

IRITIS, 569 

Atropine, the best local remedy, 569 

Counter- irritation, 570 

Daturine, scopolamine, or duboisine, when 

atropine cannot be used, 569 
Iced compress, in early stage of traumatic 

iritis, 570 
Iodide of potassium, alone or with mercury 

bichloride, following mercurial impres- 
sion in syphilitics, 570 
Leeches and dry heat or hot fomentations, 

to relieve pain, 570 
Mercury, preferably by inunction, if due 

to syphilis, 570 
Morphine, if pain is severe, 570 
Paracentesis, 570 
Pilocarpine, internally if vitreous becomes 

opaque, also in gonorrhoeal types, 570 
Salicylic acid or oil of gaultheria, followed 

later by potassium iodide, in rheumatic 

iritis, 570 
Saline laxatives, during course of disease, 

followed by iron, after cessation of 

specific treatment, 570 
Turpentine accompanied by potassium 

iodide, in plastic iritis, following second- 
ary syphilis, 570 
Zollicoffer's mixture, useful in chronic 

types, 570 

IRRITABILITY. 

Almonds, as a drink in irritability of intes- 
tines and air-passages, 54 

Cantharis, recommended in irritable blad- 
der of women and children, 114 

Cimicifuga, in uterine irritability, 148 

Hops, in vesical irritability, 203 

Petrolatum, as a soothing agent in gastro- 
intestinal types, 291 

Piperazine, in bladder irritation due to ex- 
cess of uric acid, 302 

Potassium bromide, in irritability of phar- 
ynx, 96 



JAUNDICE. 

Calomel, gr. £ (0.01), every half-hour till 
gr. \ (0.025) is taken, if due to cold, 
253 

Carbolic acid, gr. 10 (0.65), with water and 
glycerin, each 2 drachms (4.0) locally 
applied in itching of jaundice, 120 

Citric acid, 156 

Hydrastis, useful in subacute types, 204 

Iodoform, highly recommended, 220 

Leptandra, fluid extract, dose 30 minims to 
1 drachm (2.0-4.0), 238 

Manganese sulphate, may be tried in mala- 
rial types, 243 

Pilocarpine, useful unless due to malignant 
disease, 301 

Salol, said to be of value, 318 

JOINTS (ENLARGED). 

Ammoniac plaster, a useful stimulant, 64 

KELOID. 
Ichthyol ointment, 211 

KERATITIS (INTERSTITIAL), 571 

Antiseptic lotions, in marked ciliary con- 
gestion, 571 

Antisyphilitic treatment, if due to syphilis, 
571 

Atropine, in ciliary congestion, to prevent 
iritis, 571 

Creolin, 172 

Leeches, to temple to relieve pain, if pa- 
tient is not too young for bleeding, 571 

Thymol iodide, as a dusting powder, 348 

KERATITIS (PHLYCTENULAR), 571 

Atropine, to relieve pain, 571 

Boric acid, solution, to relieve congestion, 
571 

Cocaine, not advisable in photophobia, 572 

Cold-water douche on closed eyelid, to re- 
lieve photophobia, 572 

Dark glasses, to protect eyes, 571 

Tonics and alteratives, with strict hygiene 
and regulated diet, associated with local 
treatment, 572 

Yellow oxide of mercury, ointment, or calo- 
mel as a dusting powder to hasten cica- 
trization, contraindicated if iodine is 
being given, 571 

KERATITIS (SUPPURATING), 572 

Antiseptic lotions, to limit sloughing, 572 

Cautery, actual, best means of preventing 
perforation, 572 

Curetting floor of ulcer, if perforation 
threatens, 572 

Eserine or atropine, instilled into eye, to 
limit sloughing, 572 

Hot compresses, 572 

Massage of cornea and introduction of yel- 
low-oxide ointment, to remove scars of 
ulcers, 572 

Pressure bandage, if perforation threatens, 
572 

LACHRYMAL ABSCESS, 573 

Blue pyoktanin (1 : 1000), injected through 
external opening if there is puiulent 
discharge, 573 

Division of canaliculi and washing out sac 
with antiseptic fluids, and insertion of 



726 



INDEX OF DISEASES AND REMEDIES. 



probes into ducts after inflammation 
subsides, to restore patulency, 573 

Hot compresses, composed of lead- water and 
laudanum, to relieve pain, 573 

Puncture of abscess, if rupture threatens, 

LARYNGISMUS STRIDULUS. 

Amyl nitrite, 65 

Belladonna, 87 

Bromide of potassium, 97 

Chloroform by inhalation, diluted, 145 

Gelsemium, 193 

LARYNGITIS (ACUTE), 573 

Abstinence from talking, with bland and 
unirritating but nutritious diet during 
attack, 575 

Aconite, to control fever, 574 

Antipyrine, as a spray, 73 

Bromides, useful in full doses, 60 to 120 
grains (4.0-8.0) a day, 97, 574 

Calomel, small and repeated doses, fol- 
lowed by saline purges, along with hot 
mustard foot-bath and demulcent 
drinks, 574 

Dover's powder, if necessary, to give rest, 
279 

Iodine, painted over throat, useful on third 
or fourth day, 574 

Oil of amber and olive oil, half and half, 
well rubbed into the skin of the neck 
and chest, 574 

Silver nitrate, 265 

Steam inhalations, charged with benzoin, 
often advantageous to add menthol, 573 

LEUCOCYTHiEMIA. 

Arsenic, very useful in full ascending doses, 
78 

LEUCORRH(EA, 575 

Alum, gr. 10 to 20 to the ounce (0.65-1.3 
32.0), as a vaginal wash, 58 

Ammonio-ferric alum, gr. 2 to 5 (0.1-0.25), 
in atonic types, 224 

Belladonna, gr. 1 to 2 (0.05-0.1), with tan- 
nic acid, gr. 6 to 8 (0.5), applied on cot- 
ton, in disease of uterine cervix, 87 

Cantharidal collodion, applied over groins 
to produce blister, 576 

Goodell's prescription for, 576 

Hot sitz-bath, or vaginal injections of hot 
water, if due to uterine congestion, 386 

Hydrastis, injections, 204, 576 

Iron, with tonics, if due to excessive lacta- 
tion or exhausting life, 575 

Myrrh, if due to uterine trouble, 262 

Nitrate of silver, when there is cervical 
ulceration, 266 

Potassium permanganate (drachm \ [2.0], 
to water 1 pint [500 cc] ), as an injection, 
if discharge is foetid, 576 

Prescription for injection, 576 

Binger's prescription for wash, 576 

Tampon, saturated with iodoform and tan- 
nic acid, 576 

White-oak bark (ounce 1 [32.0] to water 1 
pint [500 cc.]). or tannic acid and glyce- 
rin (ounce 1 [32.0] to 2 quarts [2 litres] 
of water), as an injection, 576 

LICHEN. 

Arsenic, usually cures, 78 



Bath of sulphides, often beneficial, 337 
Cantharides, 115 

LID ABSCESS, 577 

Treatment, same as for other abscesses, 577 

LITHJEMIA. (See Gout.) 

LOCOMOTOR ATAXIA. 

Acetanilid, 42 

Antipyrine, relieves lancinating pains, 73 

Potassium bromide, to prevent laryngeal 

crises, 97 
Suspension, 401 

LUMBAGO, 577 

Acupuncture, often relieves, especially if 
pain is bilateral, 577 

Antifebrin, dose, gr. 4 to 8 (0.2-0.6), 577 

Antipyrine, dose, gr. 10 to 20 (0.65-1.3), 
577 

Chloroform liniment, 164 

Cod-liver oil, 161 

Foot-bath and Dover's powder, before re- 
tiring, often relieves, 577 

Ice-bag or ether spray to loins, if hot ap- 
plications fail, 577 

Ironing back with laundry iron, skin being 
protected by cloth or paper, very effi- 
cient, 577 

Monobromated camphor, with other drugs, 
very useful. Ill 

Mustard or capsicum plaster or blister, over 
painful spot, may relieve, 577 

Phenacetin and salol, of each 5 grains 
(0.3), 577 

Potassium iodide or salicylic acid, if recov- 
ery is slow, 577 

Turpentine, gtt. 20 (1.3), said to be useful, 
351 

LUPUS. 

Acid nitrate of mercury, 256 
Europhen, in ointment or powder, 190 
Ichthyol ointment, 211 
Iodine, as a paint, to retard spread, 217 

MALARIAL FEVER. (See Intermittent 

AND BEMITTENT FeVEKS.) 

Antipyrine, 73 

Arsenic, as a cure and prophylactic, 78 

Eucalyptus, instead of quinine, when it 

cannot be borne, 188 
Gelsemium, of doubtful value, 193 
Gentian, in malaria associated with dys- 
pepsia, 194 
Hydrastis, said to be antimalarial, 204 
Methylene blue, 1-4 grains (0.05-0.2), 258 
Phenocoll, useful in some cases, 294 
Pilocarpine, may be used to abort, 300 
Quinine, the best remedy as a prophylactic 

and a cure, 150 
Warburg's tincture, excels quinine in per- 
nicious malarial regions, 357 

MANIA (ACUTE), 378 
Anaesthetics, or apomorphine in emetic 
dose, to relax muscular system, if pa- 
tient is very violent, so that other rem- 
edies may be administered, 578 
Bromide of potassium, as a soporific, 97 
Cannabis indica, with large dose of bro- 
mides, particularly serviceable, 578 



INDEX OF DISEASES AND REMEDIES. 



727 



Chloral, in full doses, if kidneys are 
healthy, 578 

Cimicifuga, fluid extract, gtt. 20 to 30 (1.3- 
2.0), thrice daily, in cases occurring after 
confinement not due to permanent 
causes, 578 

Cold douche to head while body is im- 
mersed in hot water, often of service, 
578 

Duboisine, for insomnia, 178 

Hyoscine hydrobromate, gr. y^ (0.0006), 
when necessary to quiet patient quickly, 
578 

Morphine, in full dose, may be required to 
quiet patient, 578 

MARASMUS. 

Cod-liver oil inunctions, one of the best 
remedies, 161 

MASTITIS. (See Beeast, Inflamed.) 

MELANCHOLIA, 578 
Nitro-muriatic acid, gtt. 5 (0.3), in water 

after meals, if associated with oxaluria, 

270, 578 
Phosphorus, useful in some cases due to 

overwork, 297 

MENINGITIS (ACUTE), 578 
Aconite or veratrum viride, in early stages 

to depress circulation, 579 
Alcohol, given with food in second stage, 

if there be asthenia, 580 
Belladonna, often useful, especially when 

opium and calomel are contraindicated, 

579 
Blister to nape of neck, in early stage, .to 

prevent effusion ; also in comatose state, 

579 
Bromides and chloral, best agents to allay 

nervous symptoms, 579 
Calomel, gr. £ (0.025), with opium, gr. i 

(0.012), every half-hour, in early stage, 

until effect is manifested ; the deodor- 
ized tincture, gtt. 2 to 5 (0.1-0.3), every 

two hours, or less, preferable to powder 

of opium in some cases, 579 
Ergot, in stage of exudation, 579 
Ice-bag to head, in early stage, 579 
Leeches to nape of neck, in early stage, 

579 
Milk diet, in second stage, 580 
Opium, useful in second stage, 579 
Quinine, contraindicated in acute stage, 

579 
Venesection in early stage of sthenic cases, 

if aconite or veratrum viride is not at 

hand, 579 

MENINGITIS (CHRONIC). 

Phosphorus, 297 

MENOPAUSE. 

Bromide of potassium, in nervous disor- 
ders, 96 

Cannabis indica, alone or with aloes and 
iron, if anaemia or constipation exist, in 
headaches of the menopause, 113 

Eau de Cologne, saturated, with camphor, 
locally applied in headache or drowsi- 
ness, 110 



Valerianate of ammonium, in nervous dis- 
orders, 63 

MENORRHAGIA AND METRORRHAGIA, 

538 

Bromide of potassium or sodium, gr. 10, 
once or twice daily, if bleeding is irreg- 
ular, 97, 538 

Cannabis indica, recommended, 538 

Cinnamon oil, drachm f (2.0), when erig- 
eron is not at hand, in oozing flow, 538 

Dry cups, over sacrum, if due to conges- 
tion, 539 

Ergot, fluid extract, gtt. 10 to 60 (0.65-4.0), 
best remedy in active bleeding, 538 

Erigeron, oil of, minims 3 to 5 (0.15-0.3), in 
capsule or emulsion, the best remedy 
for oozing, 538 

Hamamelis, distilled extract, drachm 1 
(4.0), thrice daily, in irregular bleeding, 
538 

Monsel's solution (50 per cent.) full strength 
locally applied, if due to polypus, 228 

Bhus aromatica, highly recommended in 
menorrhagia, 310 

Rue, in atonic menorrhagia, 312 

Savine, oil of, gtt. 5 to 10 (0.3-0.65), in cap- 
sule or emulsion, every three or four 
hours, as a tonic in menorrhagia, 322 

Turpentine, often of value, 351 

MIGRAINE, 588 

Amyl nitrite, 65 

Bromide of potassium, with caffeine, almost 
a specific, if due to eye-strain, 97 

Cannabis indica, tincture, gtt. 20 (1.3), 
hourly, or extract, gr. \ to \ (0.01-0.015), 
every two hours, best treatment, 588 

Croton chloral, very efficient, especially 
if fifth nerve is involved, 172 

Gelsemium, with cannabis indica, to abort. 
193, 588 

Salicylic acid, of great service, in rheu- 
matic types, 314 

MILK DEFICIENCY, 618 

Electricity, 618 

Treatment for intercurrent affection, if due 
to that cause, 618 

MORPHIOMANIA. (See Poisoning from 

Opium, Chronic.) 
Bromide of potassium, 97 
Phosphorus, of service in sequelae of mor- 
phiomania, 297 

MUCOUS MEMBRANES (DISEASES OF). 

Acacia, as a mucilaginous drink in imita- 
tion and inflammation of upper air- 
passages, 39 

Bismuth, as an astringent, to inflamed 
membranes, 91 

Flaxseed, as a soothing demulcent, 191 

Glycerole of aloes, locally applied to fis- 
sures, valuable, 56 

Opium, suppositories, gr. \ (0.012), useful 
in rectal inflammation, if not an acute 
catarrh, 280 

Pareira, useful in chronic genito-urinarv 
inflammation, 287 

Terebene, useful in subacute and chronic 
genito-urinary inflammation, instead of 
sandalwood or copaiba, 345 



728 



INDEX OF DISEASES AND REMEDIES. 



Zinc sulphate, weak solution, as an astrin- 
gent, 336 

MUSOffi VOLITANTES, 580 
Alteratives and correction of anomalies of 
refraction, 580 

MUSCULAR STIFFNESS. 

Hot laundry iron passed over part, skin 
being protected by layers of paper or 
cloth, often relieves, 386 , 

MYALGIA, 580 
Ammonium chloride, if due to cold or 

bruises, 580 
Camphor liniment, 110 
Chloroform liniment, 580 
Cimicifuga, fluid extract, gtt. 20 to 1 

drachm (1.3-4.0), 580 
Clove oil, added to liniment, as a counter- 
irritant, 156 
Iodide of potassium or salicylates, if due to 

rheumatism, 580 
Iodine ointment, pure or diluted with lard, 

580 
Massage or good rubbing, very necessary, 

580 
Potassium acetate or citrate, gr. 20 (1.3), 

may be tried, 580 
Poultices, hot as can be borne, 580 
Prescription for liniment, 580 

NASAL CATARRH (ATROPHIC), 581 

Dobell's solution, as a cleansing wash ; car- 
bolic acid may be increased, or thymol 
and eucalyptus substituted for it, to re- 
lieve odor, 581 

Galvano-cautery, or strong silver-nitrate 
solution, if ulcerations are present, 582 

Hydrogen peroxide, 581 

Iodine and glycerin (gr. 6 to 8 to the ounce 
[0.4-0.6 : 32.0]), with potassium iodide 
sufficient to make solution, valuable, 
locally applied, 582 

Listerine, may be added to Dobell's solu- 
tion, to relieve odor, 581 

Potassium iodide, internally, tonics and 
stimulants to mucous membrane and 
attention to activity of skin, 582 

Potassium permanganate, useful ; painful 
if sensation is not entirely lost, 581 

Removal of necrosed bone, 582 

Silver nitrate and starch (gr. 1 to 10 [0.05] 
to drachms 2\ [10.0]), as an insufflation 
powder, or solution (gr. 1 to 10 to the 
ounce [0.05-0.65 : 32.0]), better, in some 
cases, locally applied, 585 

NASAL CATARRH (CHRONIC), 582 

Ferric alum (gr. 5 to the ounce), useful, in 
spray, in later stage, 586 

Galvano-cautery or snare, to remove hy- 
pertrophic tissue remaining after acute 
stage, 586 

Hydrastis, dilute solution, or distilled ex- 
tract of hamamelis and water, equal 
parts, useful in spray, in acute stage, 
586 

Iodine and glycerin (gr. 6 to 8 to the ounce 
[0.4-0.6 : 32.0]), with potassium iodide, 
sufficient to make solution, locally ap- 
plied, 586 

Prescription for alkaline wash, 472 



NAUSEA. (See Vomiting.) 
Hoffmann's anodyne, when due to excessive 

use of tobacco, 202 
Hydrocyanic acid, dilute, gtt. 20 (1.3), in 

water, often useful, 206 
Lime-water, 108 

NEPHRITIS. (See Bright's Disease.) 

NERVOUSNESS. 

Camphor, as a sedative, 109 

Hops, as a sedative, 203 

Musk, useful in nervous excitement and col- 
lapse ; only to be used through crisis, 261 

Phosphorus, in nervous debility and ex- 
haustion, 297 

"Pill of three valerianates," highly recom- 
mended, 353 

Rest-cure very useful where nervousness is 
due to exhaustion, 294 

Strychnine, in functional nervous atony or 
depression, 274 

Sumbul, prescription for, 342 

Sweet spirit of nitre, in nervous excitement 
of fever and other nervous states of in- 
fancy, 343 

Valerian, alone or with other drugs, 352 

NEURALGIA, 586 

Acetanilid, useful, especially with mono- 
bromated camphor, 42 

Aconite ointment (gr. 2 to the drachm [0.1 : 
4.0]), or oleate of aconitine (gr. 2 [0.1] 
to sweet oil 100), useful applied over 
painful spot, if limited in area, 588 

Acupuncture, nerve-stretching, or neurec- 
tomy necessary in some cases, 588 

Ammonium chloride, in ovarian neuralgia, 
63 

Amyl nitrite, inhalations, when due to 
anaemia, 588 

Antipyrine, very useful, especially in gout, 
rheumatism, or nervous depression, 73 

Belladonna, 88 

Bromide of potassium with caffeine, almost 
a specific, 587 

Prescription for, 97 

Camphor liniment, locally applied, to re- 
lieve pain, 110 

Chloralamide, 132 

Chloroform liniment, as a local anaesthetic, 
146 

Cimicifuga, especially useful in ovarian 
types, 148 

Cod-liver oil, 161 

Croton chloral, gr. 5 to 20 (0.3-1.3), in 5- 
grain pills, often effective in brow neur- 
algia, 588 

Freezing parts with ether or rhigolene spray 
or by small package of ice and salt, 588 

Hydrocyanic acid, useful in intestinal neur- 
algia, 203 

Iodide of potassium, may be tried in rheu- 
matic neuralgia, 213 

Iron and arsenic, in anaemia, often neces- 
sary to associate with them bitter tonics 
and cod-liver oil, 587 

Kataphoresis, 392, 588 

Morphine, gr. \ to \ (0.013), injected into 
painful spot, if localized ; not advisable 
in chronic cases, 588 



INDEX OF DISEASES AND REMEDIES. 



729 



Muriate of ammonium, useful in ovarian 
types, 63 

Mustard plaster, as a counter-irritant, 261 

Xux vomica or strychnine, if nerve is de- 
pressed by anaemia, 587 

Peppermint oil, locally applied on cloth 
over painful spot, 289 

Phenacetin, gr. 3 to 8 (0.15-0.6), very use- 
ful, 587 

Phosphorus, if due to nervous exhaustion, 
297 

Prescription for, 293 

Prescriptions containing antipyrine with 
bromides and caffeine, 588 

Quinine, if due to malaria, 587 

Best-cure very useful in exhausted patients, 
366 

Specific remedies, if due to scrofulosis or 
syphilis, 587 

Turkish bath, may relieve, if due to rheu- 
matism or gout, 388 

Veratrine ointment, locally applied over 
neuralgic nerve, 354 

NIGHT- SCREAMING. 

Bromide of potassium, 97 

NIGHT- SWEATS. 

Acetic acid, as a lotion, diluted one-half, 44 

Agaricin, of doubtful value, 48 

Alum dissolved in water or alcohol, efficient 
application for sponging, 57 

Belladonna, best remedy, 87 

Camphoric acid, the best of all remedies, 
111 

Ergot, 181 

Gallic acid, 192 

Pilocarpine, gr. 2 V (0.003) hypodermically, 
two hours before sweat, often useful, 
even when atropine fails, 301 

Sulphuric acid, with belladonna or mor- 
phine, often useful, 341 

Zinc oxide, prescription for, 285 

NIPPLES (SORE), 589 

Benzoin, tincture, locally applied, 589 

Boric acid (gr. 20 to the ounce [1.3 : 32.0]), 
or mucilage of acacia, applied after 
nursing, nipple being dried beforehand, 
589 

Breast-pump or nipple-shield may be neces- 
sary to effect cure, 589 

Cocaine (gr. 4 to the ounce [0.2 : 32.0]), ap- 
plied and washed off before nursing, if 
breast is very painful, 158, 589 

Ichthyol, when indurated, 211 

Silver-nitrate stick touched to fissure, if 
deep and slow to heal, 589 

Tannin, glycerite of, locally applied, 589 

NYMPHOMANIA. 

Bromide of potassium, of great service, 97 

OBESITY, 589 

Acetic acid, harmful, 44 

Cold bath, 592 

Diet, 591 

Laxative fruits and purges, to regulate 

bowels, 592 
Massage, passive movements, absolute 

skimmed-milk diet, and electricity, if 

exercise is impracticable, 592 



Potassium permanganate, 291 
Saline purges, 592 
Turkish bath, 592 

OPHTHALMIA. (See Conjunctivitis.) 

OPIUM HABIT. (See Poisoning from 
Opium, Chronic.) 

ORCHITIS. (See Epididymitis.) 

OSTEOMALACIA. 

Phosphorus, 297 

OTORRHGEA. 

Creolin, solution (1 : 500), used with syringe, 
172 

OXALURIA. 

Nitro-hydrochloric acid, 270 

OZ.ENA. 
Prescription for insufflation powder, 250 

PARALYSIS AGITANS. 

Cannabis indica, to quiet tremors, 112 
Chloral, of great service, 131 

PARASITES. 

Bichloride of mercury (gr. 2 [0.1] to water 
oz. 1 [32.0]), applied thrice daily in para- 
sitic skin diseases, 252 

Chrysarobin, gr. } (0.008), internally, or the 
ointment, with benzoated lard (1 : 4 
or 5), locally applied, in parasitic skin 
diseases ; must not be used on face, 147 

Hyposulphite of sodium, 1 drachm to the 
ounce (4.0 : 32.0), for parasitic skin dis- 
ease, 329 

Mercurial ointment, useful to destroy pe- 
diculus pubis or other parasites, 256 

Pyrogallol, 30 grains to ounce, for parasitic 
skin disease or psoriasis, 307 

Volatile or fixed oils, useful to destroy, 256 

PARTURITION. 

Antipyrine, for pains, doubtful, 73 
Castor oil, to relieve constipation, 125 
Chloral, if rigidity of os exists, 131 
Cimicifuga, 148 
Quinine, as a stimulant to uterus, 150 



PEMPHIGUS. 



Arsenic, 



PERICARDITIS, 592 

Aconite, to allay inflammation and quiet 
heart, 47 

Alcohol, digitalis, or caffeine, if heart shows 
signs of failure, 592 

Aspiration, gradual, if exudation endangers 
life, 593 

Blister, over prsecordium, often useful, 693 

Calomel, gr. \ (0.025), with opium, hourly, 
to prevent exudation, 592 

Ice-bag over the prsecordium, very useful, 
369 

Iodide of potassium, to aid in absorption 
of fluid, 213 

Jalap, compound powder of, gr. 20 (1.3) ; or 
elaterium, gr. \ (0.011) ; or saline purga- 
tive, before breakfast, useful in sthenic 
cases, to remove effusion, 593 



730 



INDEX OF DISEASES AND REMEDIES. 



Leeches, 5 to 10, over prsecordium, accom- 
panied by large dose of veratrum viride, 
in early stage of sthenic cases, 592 

Opium, to allay inflammation, 280 

PERITONITIS (ACUTE), 593 

Calomel, \ gr. every hour, preferably com- 
bined with opium, 596 

Hyoscyamus, by suppository or injection in 
collapse, 596 

Ice, with white of egg, for thirst. Vomit- 
ing does not contraindicate small 
amounts of water, 596 

Ice-bag or turpentine stupe, to abdomen ; 
leeches in sthenic cases, 596 

Opium, pushed until pain is relieved, but 
never to the point of obtunding intelli- 
gence, 596 

Salines, useful in cases following surgical 
operations, but contraindicated by fee- 
bleness, perforation, or obstruction, 596 

Surgical procedures, often necessary. When 
diagnosis is obscure or in septic general 
peritonitis, exploratory incision is justi- 
fied, 594, 597 

Kectal tube, milk of asafcetida or turpen- 
tine injections, in tympanites, 596, 

PERITONITIS (CHRONIC), 597 

Incision, with or without drainage and 
iodoform, useful in tubercular peri- 
tonitis, 597 
PERNICIOUS MALARIAL FEVER, 597 

Quinine, large doses, in solution, by mouth, 
rectum, or hypodermically, 597 

PHARYNGITIS. 

Antipyrine in 4 per cent, spray, 74 

Cocaine, gives temporary relief ; after-effects 
bad, 158 

Cubebs, troches of, used in chronic types, 173 I 

Monsel's solution, pure or diluted one-half 
with glycerin, applied on pledget of cot- 
ton or camel' s-hair brush, 22S 

Peroxide of hydrogen, 208 

Salol, in 5-gr. (0.3) doses, 318 

Silver-nitrate solution, in varying strength, 
locally applied, 265 

PHTHISIS. (See Tuberculosis.) 
PLEURITIS, or PLEURISY, 598 

Aconite or veratrum viride, preferable to 
venesection, in early stage, 598 

Aspiration, when hydragogue purges fail to 
remove effusion, 598 

Blisters, useful in early stage ; also during 
stage of effusion, 598, 599 

Calomel, in sthenic cases, to prevent exuda- 
tion, 594 

Cantharidal blister, two inches below axilla, 
aids absorption of effusion, 377 

Cotton jacket, 598 

Digitalis or alcohol, if pulse weakens in 
second stage, 599 

Dry cup. contraindicated over diseased 
area, may be employed over back, 598 

Elaterium or jalap, useful to remove effu- 
sion, 598 

Gelsemium, 193 

Ice-poultice or jacket, used with success in 
sthenic cases, 369 



Iodide of potassium, used in chronic stage, 
to aid absorption, 213 

Iodine, locally applied, to abort, and aid 
absorption of fluid, 217 

Poultices, 599 

Salicylates, very useful for the removal of 
effusion, 599 

Saline purges, in second stage, to remove 
effusion, 599 

Strapping chest, if respiratory movements 
are very painful, 598 

Wet cups, useful in early stage, over in- 
flamed spot, 598 

PLEURODYNIA. (See Neuralgia.) 

PNEUMONIA, 599 

Aconite, preferable to veratrum viride, in 
early stage, in children, 601 

Alcohol, inferior to digitalis, as a cardiac 
stimulant in the second stage in adults, 
but better than in children, 50, 607 

Ammonia useful for adults and children, 
604 

Ammonium chloride, as an expectorant in 
third stage, 607 

Antimony, should only be used in sthenic 
cases, 607 

Antipyrine, of great value if fever is ex- 
cessive, 72 

Belladonna, very useful if there are evi- 
dences of collapse. 87 

Blisters, applied to one side of congested 
spot, in first stage : immediately over 
spot in stage of resolution, 604-606 

Cardiac stimulants, if secondary attack is 
superimposed on first, 608 

Cayenne pepper, a valuable counter-irri- 
tant, 604 

Chloral, not advisable, 603 

Cotton jacket, 609 

Cups, dry and wet, in first stage ; also in 
secondary attack superimposed on first, 
604 

Digitalis, tincture, gtt. 5 to 15 (0.3-0.9), 
every four hours, accompanied by bella- 
donna, gtt. 5 to 10 (0.3-0.6), carefully 
watched, in second stage, 604 

Ethyl iodide, causes resolution, 188 

Expectorants, must be stopped, if secondary 
attack is superimposed on first, 608 

Gelsemium, not advisable, 603 

Ice-poultice or jacket, highly recommended 
in first stage of sthenic cases, 369. 603 

Leeching, bleeding, cupping, or cardiac 
sedatives, in sthenic cases, if secondary 
attack is superimposed on first, 608 

Mustard plaster, to chest in first stage ; to 
feet in secondary attack superimposed 
on first, 604 

Nitro-glycerin in second stage when nails 
are dusky, 605 

Oxygen inhalations, if asphyxia threatens, 
609 

Phosphorus, 297 

Pilocarpine, hypodermically, only to be 
used in earliest stage, 603 

Poultices, useful in second and third stages, 
609 

Prescriptions, containing ammonium chlo- 
ride, to loosen cough of second stage, 
608 



INDEX OF DISEASES AND REMEDIES. 



731 



Quinine, gr. 2 (0.1), thrice daily, in sup- 
pository, in lobar pneumonia of children, 
151 

Strychnine as a respiratory and circulatory 
stimulant in second stage, 605 

Turpentine stupe, in first stage ; also in 
secondary attack superimposed on first, 
604, 608 

Venesection, in early stage of sthenic cases, 
cardiac depressants preferable, 405, 601 

Veratrum viride, preferable to aconite, in 
early stage, in adults, 601 

POISONING FROM— 
Acetanilid. 

Supportive measures, stimulants, external 
heat, belladonna to maintain blood-pres- 
sure, strychnine to counteract respira- 
tory failure, and oxygen inhalations to 
overcome cyanosis, 42 

Acetate of Zinc. 
Treatment same as for gastro-enteritis, 526 

Acetic Acid. 

Large amounts of milk, alkaline liquids, 
and general treatment for gastro-enteri- 
tis, 44 

Aconite. 

Keep patient in prone position with feet 
higher than head. Hot applications; 
emetics contraindicated ; evacuate stom- 
ach by siphon or stomach-pump. Ether 
hypodermically, followed by alcohol, and 
this by digitalis. Artificial respiration 
and amyl nitrite, a few whifts, no more, 
if heart fails, 46 ; Atropine, 88 

Alcohol (Acute). 
External heat, digitalis and strychnine hy- 
podermically, in coma, if heart fails. 
Belladonna, if skin is relaxed and 
clammy, and counter-irritation to nape 
of neck, for brain symptoms. After- 
treatment, ammonia, spices, spirit of 
Mindererus ; emollients in gastritis. Ice, 
aconite, or ipecac in minute dose, and 
counter-irritation for vomiting. Jalap, 
gr. 40 (2.6), elaterium, gr. I (0.011), or 
calomel and salines, as purgatives, 50 

Alcohol (Chronic). 

Withdrawal of drug, at once or gradually. 
Highly seasoned broths, predigested 
foods, and morphine or coca, in small 
dose, if weakness is marked. Capsicum 
prescriptions (pages 51, 116), 51 

Antimony. 

Large doses of tannic acid, external heat, [ 
alcohol, digitalis, and opium hypoderm- | 
ically, if respiration is not too feeble. | 
Prone position, the patient vomiting | 
into towels. Stomach-pump, if vomit- \ 
ing is absent, 68 ; Atropine, 88 

Antipyrine. 

Maintain bodily heat, stimulants, atropine, 
and oxygen inhalations, if cyanosis is 
alarming, 72 



Arsenic (Acute and Chronic). 

Stomach-pump, external heat, stimulants, 
and the chemical antidote, hydrated 
sesquioxide of iron and magnesia. Mag- 
nesia also useful by itself. Opium should 
follow antidote, to allay pain, also large 
draughts of water to flush kidneys and 
dilute poison. For chronic poisoning, 
iodide of potassium, tonics, electricity, 
and out-of-door life, 81 

Carbolic Acid. 

Soluble sulphates, as Epsom or Glauber 
salts, warm mucilaginous drinks, hot 
applications to extremities, digitalis, 
strychnine, and counter-irritation over 
abdomen. Emetics and stomach-pump 
should be used if possible, 119 

Carbon Bisulphide. 

Potassium bromide and chloral, if convul- 
sive disorders exist, and circulatory 
stimulants if heart failure threatens, 
122 

Chloral. 

External heat, emetics in early and stom- 
ach-pump in later stages. Strychnine 
or atropine to stimulate respiration. 
Digitalis, preceded by ether, ammonia, 
brandy, or whiskey. Prone position, 
feet being elevated, 130 

Chronic poisoning, prescription for, 130 

Chloroform. 

Artificial respiration, ether and hot brandy 
hypodermically. Poles of battery with 
rapidly interrupted current swept over 
body, not over diaphragm or phrenic 
nerve. Place patient with head down- 
ward. Atropine, strychnine, and digi- 
talis to stimulate heart and respiration, 
140 

Colchicum. 

Tannic acid, emetics, and stomach-pump. 

Opium to relieve pain, and oils. Atropine 
and stimulants if collapse comes on, 163 
Conium. 

Emetics or stomach-pump, strychnine as a 
nervous and respiratory stimulant, ex- 
ternal heat and cardiac stimulants, if 
circulation fails, 167 

Copper. 

Yellow prussiate of potassium, sweet oil, 
white of egg ; followed instantly by 
emetics or stomach-pump. If emesis or 
purgation is present, emetics are contra- 
indicated ; instead, mustard plaster over 
abdomen and opium internally are to 
be employed, 169 

Corrosive Sublimate. 
Large amounts of white of egg, followed by 
stomach-pump, external heat, stimu- 
lants, 250 

Croton Oil. 
Treatment same as for gastro-enteritis, 526 

Digitalis. 
Tannic acid as a chemical antidote, emetics 
or stomach-pump, external heat to abdo- 
men and aconite as a physiological anti- 
dote. Maintain horizontal position, 177 



732 



INDEX OF DISEASES AND REMEDIES. 



Elaterium. 

Treatment same as for gastro-enteritis, 526 

Ether. 

Artificial respiration, lowering head if face 
is pale ; strychnine, atropine, and digi- 
talis hypodermically, or intravenous in- 
jection of ammonia to stimulate heart 
and respiration ; frictions and hot appli- 
cations ; ether dashed on chest and ab- 
domen, 184 

Gelsemium. 

Emetics and stomach-pump, digitalis, atro- 
pine, and ammonia as cardiac stimu- 
lants; external heat, strychnine, and 
atropine for respiratory centre, 194 

Iodine. 

Emetics or stomach-pump, large amounts 
of starch, hot applications, and hypo- 
dermic injections of alcohol, ammonia, 
atropine, digitalis, or strychnine, 215 

Iodoform. 

Sodium bicarbonate to combine witb iodine, 
alcohol, diuretics, and hot blankets, 219 

Lead (Acute). 

Epsom or Glauber salts, in large amounts ; 
emetics or stomach-pump. Hot applica- 
tions and opium to relieve pain, 233 
Lead (Chronic). 

Jalap and calomel with opium or alum, gr. 
2 (0.1), in full dose, valuable in lead 
colic. Blister to back of neck, revul- 
sives and pilocarpine in cerebral inflam- 
mation. Iodide of potassium to elimi- 
nate lead. Strychnine in progressive 
paralysis. Electricity and baths of sul- 
phuret of potassium, 235 

Mineral Acids. 

Alkalies, such as magnesium, lime, white- 
wash, and soap as antidotes ; white of 
egg, external heat, oils, and opium, to 
relieve irritation. 

Monsel's Solution. 

Soap, 228 

Nitrate of Silver (Acute). 
Common salt as the chemical antidote, 
opium and oils to allay irritation, also 
large amounts of milk and soap and 
water, 264 

Nitrate of Silver (Chronic). 

Iodide of potassium, to aid in eliminating 
poison, 264 

Nux Vomica and Alkaloids. 

Inhalations of amyl nitrite, to prevent con- 
vulsive tendencies, at the same time use 
stomach-pump. Tannic acid followed 
by physiological antidotes, potassium 
bromide, gr. 60 (2.0), with chloral, gr. 
20 (1.3). If convulsions prevent swal- 
lowing, chloroform patient carefully 
and give antidotes by rectum in starch- 
water. Amyl nitrite, hypodermically, 
if relaxation does not occur, 273 



Opium (Acute). 
Emetics or stomach-pump, tannic acid, 
black coffee, electricity, and other meas- 
ures to keep patient awake. Atropine 
or strychnine, hypodermically, if res- 
piration fails. Alcohol, ammonia, and 
external heat. Artificial respiration 
may be necessary ; repeated washing 
out of stomach, 277 

Opium (Chronic). 

Decrease a sixth or fourth of customary 
amount each twenty-four hours. Co- 
caine not advisable as a substitute, as 
the cocaine-habit may be established. 
Digitalis if heart fails, 278 

Phosphorus. 

Sulphate of copper as the chemical anti- 
dote ; acts as an emetic if given in ex- 
cess, 296 

Physostigma. 

Atropine as a physiological antidote, exter- 
nal heat, and cardiac and respiratory 
stimulants, 298 

Scammony. 

Treatment same as for gastro-enteritis, 526 

Strychnine. (See Nux Vomica.) 

Tobacco. 

Strychnine, cardiac stimulants, external 
heat, and atropine, 349 

Veratrum Viride. 

Prone position, head higher than feet ; atro- 
pine, strychnine, external heat, and 
cardiac stimulants, 355 

POST-PARTUM HEMORRHAGE, 616 

Auto-transfusion, or actual transfusion of 
weak salt solution, necessary in some 
cases, 618 

Beef-tea, ^ pint (250 cc), and morphine, 
gr. ■} (0.01) hypodermically, after reac- 
tion is established, 618 

Enema, of hot water, 1 pint (500 cc), after 
cessation of bleeding, 617 

Ergot, as a cure and prophylactic, 617 

Ether, hj^podermically, if symptoms of 
shock are manifested, followed by small 
doses of hot, strong brandy and water, 
and warm milk, 617 

Hirst's method of controlling, 616 

Suture, if due to laceration, 617 

PRIAPISM. 

Hops, 203 

PROLAPSUS ANI AND RECTI. 

Injection of cold or hot water, often re- 
lieves, 373 

PROSTATITIS. 

Cold-water injections and perineal douches, 
373 

Local treatment to prostatic urethra, and 
use of cold steel sounds in chronic types, 
533 

Perineal incision, to evacuate pus, if ab- 
scess forms, 533 



INDEX OF DISEASES AND REMEDIES. 



733 



Eest in bed, regulation of bowels, leeches 
to perineum, medication to render urine 
alkaline, and morphine hypodermically 
or in suppository, 533 

Soft catheter, allowed to remain in bladder, 
if retention of urine is persistent, 533 

PROSTATORRHCEA. 
Cantharides, 115 

PRURIGO. 

Cantharides, 115 

PRURITUS, 609 

Alum solution in pruritus vulvae, 58 
Arsenic, quinine, bitter tonics, cod-liver 
oil, alkaline diuretics or mineral waters 
in debility, and avoidance of condi- 
ments if mouth of vagina or urethra is 
affected, 610 
Calomel and lard (1 drachm to the ounce 

[4.0 : 32.0]), locally applied, 254 
Cocaine, relieves temporarily, 610 
Cold douche and injections highly recom- 
mended in pruritus ani and vulvae, 374 
Goulard's extract, dilute, useful in pruritus 

pudendi, 237 
Hydrocyanic acid, locally applied, 207 
Prescriptions for lotions and ointments, 610 
Salicylic acid, prescription for, 315 
Silver nitrate (gr. 20 to the ounce [1.3; 
32.0]), locally applied, preceded by co- 
caine, if itching is intense ; a 4- to 6- 
grain (0.2-0.3) solution may relieve itch- 
ing of pruritus pudendi, ani. and vulvse, 
266, 610 
Sodium bicarbonate or borax (1 drachm to 

the pint [4.0 : 500 cc.]), as a wash, 610 
Teucrium scordium, highly recommended 
by Brinton, 610 

PSEUDO-LEUCOCYTH.EMIA. 

Arsenic internally, and injections of Fowl- 
er's solution into glands, 78 

PSORIASIS. 

Anthrarobin, 66 

Aristol, 348 

Arsenic, 79 

Baths of sulphides, very useful, 337 

Chrysarobin, gr. -J internally, or the oint- 
ment with benzoated lard (1 to 4 or 5) 
locally applied, face excepted, 147 

Gallic acid, ointment, 192 

Prescription for application, 147 

Pyrogallol, 30 grains to ounce (2.0 : 32.0) of 
lard, 307 

Besorcin, prescription for, 309 

Tar, locallv applied, 304 

Thymol iodide, 347 

PTYALISM. 

Alum, applied on swab, in mercurial ptyal- 

ism, 58 
Belladonna, in idiopathic or mercurial 

types, 87 

PUERPERAL DISEASES, 610 

(For treatment, see special titles.) 

PUERPERAL FEVER, 611 

Antipyretics, best abstained from as long as 
possible, 612 



Bichlorate of mercury (1 : 2000), or creolin 
(2 per cent.), solutions, as antiseptic in- 
jections, 611 

Boric acid, creolin (2 per cent.), or bichlo- 
ride (1 : 8000), solutions, as injections 
into bladder, to prevent septic cystitis, 
614 

Curette or placental forceps, to remove 
membranes if fever continues after an- 
tiseptic injections, 611 

Epsom salts, concentrated solution, 2 
drachms (8.0) every fifteen minutes, if 
peritonitis develops, 613 

Laparotomy, occasionally saves life, if sep- 
tic peritonitis develops, 612 

Nutriment in large amounts and alcoholic 
stimulants, if symptoms of systemic in- 
vasion arise, 612 

Silver nitrate (gr. 40 to 60 to the ounce 
[2.0-4.0:32.0]), locally applied to un- 
healthy ulcerated wounds ; zinc-chlo- 
ride solution may be necessary, 613 

Veratrum viride, 355 

PURPURA HEMORRHAGICA. 

Turpentine, 351 

PYELITIS. 

Buchu, in chronic types, 102 

Cantharides, 114 

Copaiba, 168 

Juniper, as a tonic in chronic types, 231 

Uva ursi, 352 

QUINSY. 

Aconite, in early stage, 47 

Salicylic acid, gr. 3 (0.15), hourly, acts as a 

specific, especially if due to rheumatism^ 

315 

REMITTENT FEVER, 621 

Antipyrine, or cold pack, if fever is exces- 
sive, 622 

Eupatorium, 189 

Monsel's salt, gallic or tannic acid inter- 
nally, if intestinal hemorrhage occurs, 
622 

Morphine, spirit of chloroform, or aconite, 
in sthenic cases, to control vomiting, 
622 

Phenocoll, in 5 to 8 grains (0.3-0.6), 294 

Quinine, gr. 20 to 30 (1.3-2.0), preceded by 
calomel, gr. 3 to 4 (0.15-0.2) ; if not re- 
tained, administer by rectum, or hypo- 
dermically, with divided doses of Seid- 
litz powder by mouth, 622 

Tonics, potassium salts, to regulate kidneys, 
and purgatives, if necessary, during 
convalescence, 622 

Turpentine stupe, if belly is tender, 622 

RETINITIS, 622 
Atropine, dark glasses, and later suitable 
lenses, if due to eye-strain, 622 

RHEUMATISM (ACUTE ARTICULAR), 623 

Acetanilid, relieves pain and fever, 43, 625 

Acetate of potassium, 44 

Aconite, or veratrum viride, useful at onset 

of inflammation in sthenic cases, 623 
Alcohol, in depression, 623 



734 



INDEX OF DISEASES AND REMEDIES. 



Ammonium bromide and phosphate, 62, 64 
Antipyrine, gr. 10 to 20 (0.65-1.3), or anti- 

febrin, gr. 4 to 8 (0.2-0.4), often very- 
valuable, 625 
Benzoic acid, drachm 2 to 3, daily, said to 

be a specific, 90 
Bicarbonate or citrate of potassium, gr. 20 

to 30 (1.3-2.0), in water, every five 

hours, in obstinate cases, 626 
Blisters over joints, useful after systemic 

disturbance is past, 627 
Camphor liniment, 110 
Capsicum plaster, 117 
Cimicifuga, shortens attack and relieves 

pain in some cases, 622 
Colchicum, prescription for, 626 
Cold pack, if fever threatens life, 624 
Fuller's lotion, applied on hot cloths to 

joints, 623 
Ice-cold compress, may relieve inflamed 

joints, 623 
Ichthyol, ointment, valuable applied to 

joints, prescription for, 624 
Iodine, ointment or tincture, painted over 

parts, 627 
Lemon- or lime-juice, or citric acid, bene- 
ficial in nearly all cases, 627 
Oil of gaultheria, useful as a substitute for 

salicylic acid, 625 
01. succini, applied locally over joints, 58 
Phenacetin, alone or with salol, 626 
Potassium iodide, useful in subacute or ob- 
stinate types, prescription for, 626 
Potassium nitrate, 263 
Bhus toxicodendron, especially useful for 

night pains, 627 
Salicylic acid, gr. 20 (1.3) thrice daily ; if 

untoward symptoms arise must be 

stopped, 624 
Salicylic acid, applied to joints in a salve 

when stomach is irritable, 624 
Salol, useful as a substitute for salicylic 

acid ; dangerous in large doses, 617 
Sodium bicarbonate (gr. 20 to the ounce 

[1.3 : 32.0]), to inflamed joints, 623 
Splints for fixation of limbs, may relieve 

greatlv, 624 
Sulphur, 339 
Vera trine ointment, useful locally, applied 

to joints, 627 

RHEUMATISM (CHRONIC), 627 

Arsenic, useful in some cases, 79 
Baths of sulphides, often useful, 337 
Cimicifuga, sometimes relieves, 148 
Citrate of potassium or sodium, gr. 30 to 60 

(2.0-4.0), before retiring, 314 
Cod-liver oil. internally, in weakness or 

anaemia, also useful rubbed into joints, 

627 
Ichthyol, the best remedy for joints, 629 
Iodine, locally applied, 628 
Liniments, prescriptions for, 628 
Ointments, prescriptions for, 628 
Potassium iodide, colchicum, and sarsa- 

parilla, usually indicated ; see prescrip- 
tion, 627 
Turkish or Bussian baths, verv valuable, 

628 
Veratrine ointment, gives greatest relief in 

some cases, prescription for, 628 



RHEUMATISM (MUSCULAR). 

Burgundy pitch, a mild local remedy, 303 
Dover's powder, in conjunction with hot 

drinks and hot foot-bath, often cures, 

281 
Mustard, as a counter-irritant, 261 
Veratrine ointment, locally applied, 354 

RHINITIS. 

Creolin (1 : 1000), as a nasal douche, 172 
Fluid cosmoline, in spray, 291 
Potassium permanganate, solution, in foetid 
rhinitis, 291 

RICKETS, 629 

Arsenite of copper, 629 

Cinchona, for child of one year or more, 
prescription for, 630 

Cod-liver oil, prescription for, 630 

Cool sponging or rubbing with salt and 
whiskey (1 drachm to the pint [4.0 : 
500 cc.]), useful at night, 630 

Iodide of iron, syrup of, if scrofulous tend- 
encv or anaemia exists, prescriptions for, 
630 

Lime salts, phosphorus, zinc phosphate, as 
bone tonics, 629 

Massage and passive movements, 630 

Mineral acids, physostigma, and simple 
bitters, as digestive tonics, 629 

Nux vomica, rarely given because of bitter- 
ness, 630 

Phosphate of lime or sodium, gr. 1 to 2 
(0.05-0.1), in child's milk, 630 

Phosphorus (gr. T ^ [0.0006]), in sugar- 
coated pill, 630 

Quinine, cod-liver oil, nux vomica, and 
iron as general tonics, 629 

Sodium and lime salts, useful in nursing 
and pregnant women, 630 

RINGWORM. (See Tinea Cikcinata.) 

SATYRIASIS. 

Potassium bromide, one of the best rem- 
edies, 97 

SCABIES. 
Sulphur, the best remedy, 340 

SCARLET FEVER, 631 

Aconite, harmful. 47 

Alcohol, indicated in collapse, 632 

Antipyrine or acetanilid, may produce col- 
lapse in large doses, 633 

Bromide of sodium, with chloral, useful 
when convulsion ushei'S in attack, 632 

Carbolic acid (gtt. 2 [0.1] to olive oil oz. 2 
[64.0] ), beuzoated lard, vaseline, cosmo- 
line, or almond oil, useful, locally ap- 
plied, to allay itching, 633 

Chloral, very useful, prescription for, 632 

Chlorate of potassium, locally applied, by 
spray or swab, in sore throat, 633 

Cold sponging, useful ; pack must be em- 
ployed if fever is excessive, 633 

Ice, applied externally and held in mouth, 
to prevent swelling of throat, 633 

Ice-bag or rubber head-coil to head, if verv 
hot, 633 

Jalap, compound powder, with potassium 
bitartrate, or hot dry applications, to 
produce sweat, in nephritis, 634 



INDEX OF DISEASES AND REMEDIES. 



735 



Juniper, in later stages, if there is renal 

atony, 231 
Pilocarpine, best agent to produce sweating 

in nephritis ; contraindicated if heart is 

weak, 634 
Potassium citrate and sweet spirit of nitre, 

prescription for, 632 
Quinine, unsuccessful in most cases, 633 
Salicylic acid, highly recommended, pre- 
scription for, 631 
Strychnine, iron, simple bitters, quinine, or 

Basham's mixture, in convalescence, 

634 
Warm wet pack, useful to bring out rash, 

633 
Water, pure, such as Vichy or Poland, in 

large amounts, 632 

SCIATICA, 634 

Absolute rest of limb in splints very needful, 

635 
Acetanilid and antipyrine. 634 
Acupuncture, recommended, 635 
Cod-liver oil, of service in obstinate cases, 

635 
Chloroform, deeply injected over exit of 

nerve, a favorite remedy, 635 
Ether or rhigolene, sprayed on part, often 

effective, 635 
Kataphoresis, may be tried, 635 
Liniments for rheumatism may be tried, 

635 
Massage of nerve with glass rod, 635 
Morphine, injected over course of nerve, 

635 
Nerve-stretching, 635 
Potassium bitartrate or citrate, gr. 40 (2.6), 

thrice daily, in plenty of water, to reg- 
ulate kidneys, 634 
Potassium iodide, 213 
Eemedies for rheumatism, often relieve, 

635 
Salicvlic acid, 314 
Sulphur, 339 
Wet cups, highly beneficial over course of 

nerve, 635 

SCLERITIS, 635 

Atropine, boric acid, and hot-water com- 
presses, in early stage, 635 

Eserine, with pilocarpine sweats or cautery, 
in stubborn episcleritis without iritis, 
635 

Specific treatment, in syphilitic cases, 635 

Yellow -oxide ointment, associated with 
massage, to subdue infiltration, 635 

SCLEROSIS. 

Antipyrine, 73 
Nitrate of silver, 265 

SCROFULOSIS, 635 

Arsenic or corrosive sublimate, useful if 
ansemia is present, prescriptions for, 
636 

Calcium chloride, 105 

Cod-liver oil, the best remedy, 636 

Diet and exercise, 635 

Europhen in scrofuloderm, 190 

Excision, or scraping gland, and packing 
with iodoform gauze, if other treat- 
ments fail, 636 



Ichthyol ointment, useful, rubbed into per- 
sistent enlargements, prescription for, 
636 

Iodine ointment and lard, equal parts, 
rubbed into glands, stopping at first 
sign of reddening or fluctuation, 636 

Iron, syrup of the iodide in anaemia, pre- 
scription for, 636 

Lactophosphates, or hypophosphates, with 
cod-liver oil, useful in young children, 
636 

Phosphate of sodium or lime, if glands are 
breaking down, 636 

Sulphurate of calcium, if suppuration is 
active, 636 

Thiol, recommended in scrofulous skin dis- 
eases, 347 

SCURVY, 637 

Arsenic and iron, of service in most cases, 
637 

Citric acid, if lemon-j uice is not obtainable, 
637 

Diet, 637 

Lemon- or lime-juice, particularly indi- 
cated, 637 

SEA-SICKNESS. 

Bromides, the best prophylactics, 97 
Chloralamide and potassium bromide, 132 
Nitrite of amyl, 58 
Kola, 232 

SHOCK, 637 

Alcohol, 50 

Atropine, gr. -£$ to -^ (0.001), hypodermi- 
cally, with hot applications, very useful 
in first or second stage, 638 

Digitalis, valuable as an adjuvant to atro- 
pine, 638 

Heat, external, very useful, 638 

Hypodermoclysis, useful, 638 

Strychnine, very valuable, 275 
SKIN DISEASES. 

Arsenic, in dry, scaly types, 78 

Cod-liver oil, in strumous types, 161 

Copper sulphate gr. -^ (0.005), thrice daily, 
if arsenic is not well borne, 169 

Corrosive sublimate, oz. \ (16.0), and am- 
monium chloride, oz. 1 (32.0), useful, 
added to bath in syphiloderm, 251 

Hydrocyanic acid, in itching types, pre- 
scription for, 207 

Ointment of yellow oxide and lard, in 
equal parts, a useful application, 257 

Petrolatum, as an emollient dressing, 291 

Tar and suet, equal parts, locally applied 
except on face, 304 

Unguentum hydrargyri ammoniati, 250 

Zinc-oxide ointment, 284 

SMALLPOX, 638 

Aconite, with spirits of nitre and Min- 
dererus, useful as a fever mixture, 639 

Antipyrine or acetanilid, to control head- 
ache and backache, 639 

Brandy and whiskey, if pulse fails, 639 

Bromides and chloral, in insomnia; latter 
used carefully, 639 

Carbolic acid and sweet oil (1 : 100), as an 
ointment to check irritation, 639 

Chlorate of potassium with tincture of 
myrrh, as a mouth- wash, 639 



736 



INDEX OF DISEASES AND REMEDIES. 



Flexible collodion, glycerite of starch, or 

simple cerate, locally applied, to prevent 

itching, 639 
Iron, tincture of the chloride, to give 

strength and act as a specific, 639 
Salicylic acid and vaseline, or cold cream 

(4 : 100), best local application, 639 
Silver nitrate, locally applied, to prevent 

pitting, 639 

SORDES. 

Glycerin and water, equal parts, useful as 
a mouth-wash, 197 

SORES. 

Acetic acid, in old sores, 44 

Black wash, useful for syphilitic sores, 252 

Camphor, locally applied, as a stimulant in 
indolent sores, 109 

Charcoal, applied to old sores, as a deodor- 
ant and antiseptic, 121 

Cold cream, as an emollient dressing, 311 

Iodoform, gr. 20, with oil of eucalyptus, 
oz. £ (16.0), or iodoform, oz. h (16.0), 
camphor, gr. 75 (5.0), and essence of 
roses, gtt. 2 (0.1), as a dressing for syph- 
ilitic sores, 220 

Petrolatum, as an emollient dressing, 291 

Potassium permanganate (gr. 60 to the 
pint [4.0 : 500 cc] ), as a wash, 291 

Quercus alba, powdered, as a poultice, to 
check discharge, 308 

Red or yellow oxide of mercury, a good 
dressing for syphilitic sores, 257 

Salicylic acid, ointment, 2 per cent, for sores 
from riding in a saddle, 315 

Sulphuric acid, sometimes used as an es- 
charotic in venereal sores, 341 

Zinc-oxide ointment, 284 

SORE THROAT. 

Aconite, in early stage, 47 

Alum (gr. 20 to the ounce [1.3 : 32.0]), lo- 
cally applied on swab, 57 

Belladonna, of greatest service in some 
cases, 88 

Capsicum, tincture of, and glycerin, 116 

Carbolic acid (1 : 100), in sprav, in ulcerated 
types, 120 

Catechu, as a gargle or in troches, 126 

Copper sulphate (gr. 4 to the ounce [0.2 : 
32.0]), often of service in relaxed sore 
throat, 169 

Hamamelis, in relaxed sore throat, 201 

Hydrogen peroxide (2 per. cent, strength), 
in spray, in foetid types, 208 

Kino, as a gargle, 232 

Myrrh, tincture of, diluted one-half, as a 
gargle, in ulcerated types, 262 

Quercus alba, useful as a gargle, 308 

Quinine (gr 1 to 2 to the ounce [0.05-0.1 : 
32.0]), in spray, in foetid sore throat, 
152 

Rhus glabra, with glycerin and water, use- 
ful as a gargle, 311 

SPASMS. 

Belladonna, useful in urethral, anal, and 

vesical spasms, 87 
Cannabis indica, useful in vesical spasm, 

112 



Conium, useful, if due to irritation of 

nerve-trunk, 166 
Ether, inhalation, relieves local spasms, 

186 
Nitrite of amyl, of service to relax, 65 

SPERMATORRHOEA. (See Emissions.) 

SPRAINS, 639 
Arnica, 76 

Camphor liniment, 110 
Cold applications, useful in sprained ankle, 

367 
Hot foot-bath, prolonged for hours, very 

useful in sprained ankle, 386 
Ichthvol ointment, well rubbed in, very 

useful, 211 
Lead-water and laudanum, 236 
Soap liniment, 327 
Soap plaster, used as a support to sprained 

joints, 327 
Turpentine liniment, 352 

STINGS AND BITES, 639 

Ammonia or alkaline liquids, locally ap- 
plied to neutralize poison, 639 

Carbolic acid (1 : 50 or 100), sponged over 
part, useful in mosquito-bites, 639 

Corrosive sublimate, with flexible collodion 
(1 : 1000), painted over part; salicylic 
acid a useful addition, 639 

Ligature, or cleansing of wound, at once, 
to prevent absorption in snake-bite, 640 

Potassium permanganate, applied and in- 
jected around snake-bite, followed by 
alcohol in full dose, 640 

Vinegar, dilute or pure, locally applied, 
often relieves insect-bites, 640 

STOMATITIS, 640 

Borax, as a mouth-wash, prescription for, 
640 

Bromide of potassium or sodium, gr. 1 to 
3 (0.05-0.15), thrice daily, when nervous 
irritability is excessive, 641 

Carbolic acid, as a mouth-wash, 120 

Cleansing nipples, in breast-fed babies, 641 

Cocaine, before cauterization, 158 

Nitrate of silver, stick touched to sore spots 
when they fail to yield to other treat- 
ment, 640 

Nitric acid, gtt. 3 (0.15), in water, taken 
through tube, 267 

Nitro-muriatic acid, indicated when he- 
patic torpor exists, 640 

Peroxide of hydrogen, 640 

Potassium chlorate, prescription for, 640 

Salicylic acid (1 : 250), as a mouth-wash, 
after blisters have broken, to allay pain, 
315 

Salines or rhubarb, if constipation exists. 
640 

Sozoiodol (5 per cent, solution), locally ap- 
plied, 330 

Sweet spirit of nitre, 10 drops (0.65). well 
diluted, to a one- or two-year-old child, 
and a warm foot-bath, before retiring, 
to produce rest, 641 

Thymol, prescription for, 347 

Tonics and careful diet after the attack, 
641 



INDEX OF DISEASES AND REMEDIES. 



737 



STYES, 641 
Boric acid (saturated solution), collodion 
(ethereal solution), or red or yellow ox- 
ide of mercury salve (gr. 2 to the ounce 
[0.1-34.0]), locally applied, to abort, 
641 
Calcium sulphurate, if they tend to return, 

641 
Hot compresses, to alleviate pain, 641 
Incision, as soon as pus forms, 641 
Tonics, if general health is poor, 641 

SUBINVOLUTION OF UTERUS. (See In- 
volution, Anomalies of.) 

SUNBURN. 

Almonds, in emulsion, 54 

SUNSTROKE, 641 

Antipyretics, almost useless, 642 

Hot baths (105° to 110° P.), or hot bottles 
or bricks, in heat exhaustion, 643 

Ice, application to chest, back, and abdo- 
men, as quickly as possible, in thermic 
fever, 642 

Salicylic acid, quinine, and similar drugs 
contraindicated, 642 

Tonics, during convalescence in heat ex- 
haustion, 642 

Venesection, best treatment, if meningitis 
threatens, after thermic fever, 642 

Veratrum viride may be used if meningi- 
tis threatens, 642 

SYNCOPE. 

Ammonia, if due to shock or indigestion, 

60 

SYNOVITIS. 
Carbolic acid (2 per cent, strength), as an 

injection in chronic types, 120 
Counter-irritation, 377 

SYPHILIS, 643 

Bismuth and calomel, as a dusting-powder, 
or bichloride solution (1 : 2000), locally 
applied to mucous patches about geni- 
talia, 615 

Calomel, gr. J (0.011), every two hours, for 
cephalalgia, 645 

Cod-liver oil. useful in advanced cases, 647 

Expectant plan of treatment, 644 

Hypodermic injections of mercury, 647 

Iodides, followed if necessary by mercury, 
recommended by some, 644 

Iodoform, gr. 1 to 5 (0.05-0.25), internally 
in tertiary stage, and the ointment ap- 
plied to ulcers, very useful, 220, 647 

Iodol, in tertiary stage, 221 

Mercury, at beginning of secondary stage, 
followed later by the iodides. 644 

Mercury, by fumigation, general and local, 
246 

Mercury, with chalk, chiefly employed in 
infantile syphilis, 255 

Mixed treatment, 646 

Ointments and washes of mercury, and 
hot applications, to combat surface erup- 
tions, 645 

Prescription for blue mass and iron, 646 

Prescription for potassium iodide and mer- 
cury, to be used after first eighteen 
months, 646 



Pressure bandage and mercurial inunctions 

for periostitis, 645 
Pussian baths, highly recommended, 390 
Sarsaparilla, a useful adjunct to potassium 

iodide, 321, 648 
Shampooing and local application of croton 
oil or cantharides, as a lotion, to com- 
bat alopecia, 645 
Silver nitrate, copper sulphate, chromic 
acid, solution (20 per cent.), or acid ni- 
trate of mercury, locally applied to mu- 
cous patches in mouth, 645 
Stillingia, used as an aid to other drugs, 

333 
Thiol, in syphilides, 347 
Tonic and general treatment, 647 
Vapor baths, hypodermic injections, or in- 
unctions, useful modes of applying mer- 
cury, if it cannot be taken by mouth, 
646 

SYSTEMIC STRAIN. 
Opium, useful in prolonged physical strain, 
281 

Quinine, gr. 2 to 4 (0.1-0.2), useful to pre- 
vent exhaustion following physical and 
mental strain, 151 

TABES DORSALIS. (See Locomotor 
Ataxia.) 
Chloralamide, 132 

TAPE-WORM. (See Worms.) 

TEETHING. 

Bromide of potassium, to prevent convul- 
sions, 97 

TETANUS. (See Poisoning from 
Strychnine.) 
Amyl nitrite, to relieve and prevent, 65 
Chloral and bromide of potassium, by 

mouth or rectum, 130 
Fowler's solution, said to be almost specific 

in some cases, 648 
Physostigma, of moderate value, 298 

TINEA CAPITIS. 

Lime-water, locally applied, 108 

TINEA CIRCINATA. 
Borax, strong solution, locally applied, 93 
Iodine, applied with camel's-hair brush, 

217 
Turpentine, useful, applied with a brush, 



TINEA TARSI. 
Copper, crystal, or weak solution, applied 
to diseased eyelid, 169 

TINEA TONSURANS. 
Borax, strong solution, locally applied, 93 
Iodine, applied with camel's-hair brush, 

217 
Oil of cajuput, applied pure, 104 

TOE-NAIL (INGROWING). 

Absorbent cotton, soaked in strong alum 
solution, and inserted under nail, 58 

Liquor potassae, to soften nail prior to pack- 
ing with cotton or partial evulsion, 239 



738 



INDEX OF DISEASES AND REMEDIES. 



TONSILLITIS, 648 

Alum stick, deeply applied, 58 

Ammonium iodide, for enlarged tonsils, 64 

Carbolic acid, solution (1 : 100), as an anti- 
septic gargle, 649 

Glycerin and tincture of capsicum, equal 
parts, applied by swab, 197 

Hydrogen peroxide (2 per cent, strength), 
in spray, in ulcerative types, 208 

Ice-bag to throat and pieces of ice in mouth, 
also internally in full doses, 648 

Iron, tincture of the chloride, locally ap- 
plied, 648 

Monsel's solution, pure, applied with cam- 
el's-hair brush, 228 

Nitrate of silver, applied locally, 648 

Salicylates, are valuable in rheumatic cases, 
649 

TOOTHACHE. 

Creosote, applied on cotton, often relieves, 
170 

Oil of cloves, inserted into cavity on cot- 
ton, 156 

Oil of peppermint, applied on cotton, 289 

TORPOR. 

Ammonium chloride, in hepatic torpor, 63 

Euonymus, in mild hepatic torpor, 189 

Lactophosphates and hypophosphites, use- 
ful in hepatic torpor, 106 

Nitro-hydrochloric acid, in torpor of liver, 
270 

Oxygen-water, after meals, useful in sys- 
temic torpor, 285 

Potassium acetate, exceedingly useful in 
hepatic torpor, 43 

Russian and Turkish baths, useful in tor- 
pidity of skin and kidneys, 388 

Saline purgative, followed by fever mixture 
of aconite, sweet spirit of nitre, and po- 
tassium citrate, 646 

Taraxacum, in hepatic torpor, 345 

TORTICOLLIS. 

Belladonna, injected into muscle, 87 
Gelsemium, 193 

TREMOR. 

Hyoscine, 210 
Sparteine, 324 

TUBERCULOSIS, 649 

Acetanilid, generally acts unfavorably, 42 

Almonds, essential oil of, recommended in 
cough, 54 

Alum (gr. 10 to 20 to the ounce [0.65-1.3 : 
32.0]), or sulphuric acid (1 drachm to 
the pint [4.0 : 500 cc.]), useful, sponged 
over body in night-sweats. 652 

Antipyrine, harmful, 72 

Arsenic, in phthisical tendencies, 78 

Atropine, gr. fa to fa, hypodermically, in 
excessive night-sweats, 652 

Blister, small, useful over new pleuritic 
spots, 652 

Camphoric acid, gr. 20 to 30 (1.3-2.0), in- 
valuable, 653 

Cannabis indica, 112, 651 

Carbolic acid (gtt. 5 to 15 to the ounce [0.3- 
1.0 : 32.0]), in spray, 120 



Chloroform, spirit of, used by inhaler, often 
relieves cough, 145, 651 

Climatic treatment, 399 

Codeine, recommended in excessive cough, 
160 

Cod-liver oil, rules for its use, 650 

Creosote, internally, in spray or by inhaler, 
often relieves cough and discomfort ; 
contraindicated if fever and haemoptysis 
are present ; prescription for, 650 

Glycerin and water, equal parts, with lem- 
on-juice, useful as a mouth-wash, 197 

Hydrogen peroxide (2 per cent, strength), 
in fine spray in laryngeal phthisis, 208 

Inhalations of steam from corrosive-subli- 
mate solution (1 : 10,000), stopping at 
first sign of mercurial effects, in laryn- 
geal phthisis ; precede inhalation with 
cocaine spray (4 per cent, solution), 652 

Iodine, useful, painted over new pleuritic 
spots, also useful in chronic cases as an 
inhalation, 217, 652 

Iodoform with small amount of powdered 
talc and a little morphine, useful when 
puffed into the larynx in laryngeal tu- 
berculosis, 652 ; also used in spray, 220 

Iodoform emulsion (10 per cent,), useful in 
tubercular abscess, 220 

Iodol, of use in tubercular laryngitis, 221 

Lactic-acid applications (10 to 60 per cent, 
solution), in laryngeal tuberculosis, 
using cocaine sprav first to relieve pain, 
652 

Lactophosphates and hypophosphites, 106 

Morphine and wild-cherry bark, in cough, 
prescription for, 651 

Opium, may be given in last stage, to re- 
lieve pain and discomfort, 281 

Oxygen, inhalations in dyspnoea, 285 

Pilocarpine, gr. fa (0.003), one to two hours 
before sweat, sometimes arrests ; if it or 
atropine fails alone, give them together, 
652 

Potassium cyanide, in excessive cough, pre- 
scription for, 174, 651 

Silver nitrate (gr. i to 2 to the ounce [0.05- 
0.1 : 32.0]), in spray, may be tried in 
laryngeal types, 265 

Strychnine, in dyspnoea, 275 

Sulphuric acid, internally, may "relieve 
night-sweats, 652 

TYPHOID FEVER, 653. (See Fever.) 

Acetanilid, generally acts unfavorably, 42 

Alcohol, useful throughout course of dis- 
ease, 52, 654 

Asafoetida, by rectal injections, in tympa- 
nites, 82 

Brand's method of cold bathing, 656 

Calomel, gr. £ (0.011), every fifteen min- 
utes, till gr. 1 (0.05) is taken, followed 
by magnesium sulphate, £ ounce (16.0), 
if constipation lasts two days, 655 

Enemas, to be tried first, if constipation 
lasts over two days. 655 

Glycerin and water, equal parts, with a 
little lemon-juice, as a mouth-wash, if 
sordes are present, 655 

Hydrochloric acid, dilute, gtt. 5 (0.3), every 
few hours, or, if bowels are inactive, ni- 
tro-hydrochloric acid, gtt. 3 (0.15). 6'ir, 



INDEX OF DISEASES AND REMEDIES. 



739 



Lime-water added to milk, if vomiting 

threatens, 655 
Liquorice powder, drachm 1 (4.0), if con- 
stipation lasts over two days, 655 
Morphine in large dose, if perforation oc- 
curs. 656 
Phosphorus, if nervous svstem is affected, 

297 
Prescription for diarrhoea, 656 
Quinine inferior to new antipyretics, 151 
Eest and diet, 653 

Silver nitrate, gr. \ to I (0.011-0.015), high- 
ly recommended. 265 
Sulphocarbolate of zinc, useful, 337 
Turpentine, in the form of stupes, enemata, 
or by mouth, in tympanites, also useful 
in later stage, to relieve diarrhoea, heal 
ulcers, and prevent relapse, 656 
(For remedies for complications — intesti- 
nal hemorrhage, pneumonia, and pleurisy 
— see their titles.) 

ULCERS. 

Alcohol, a useful local application, 50 

Aristol, 348 

Benzoate of bismuth, as a dressing for in- 
dolent or sloughing ulcers, 89 

Burnt alum, as a dressing for old ulcers, 58 

Caustic potash, as an escharotic for exu- 
berant ulcers, 127 

Chimaphila, said to be of service in stru- 
mous ulcers, 128 

Copper, in solid or powder form, locally 
applied to indolent ulcers, 169 

Creolin, solution (1 : 100), as a douche for 
nasal ulcers, 172 

Europhen, in 10 per cent, ointment, in leg 
ulcers, 190 

Gallic-acid ointment, in actively discharg- 
ing ulcers, 192 

Hamamelis, locally applied on a cloth, re- 
lieves leg ulcers, 201 

Hot pack to increase activity of skin, 658 

Hvdrogen peroxide, a useful application, 
208 

Lime, as an escharotic in old ulcers, 107 

Nitric acid, as a caustic for phagedenic 
ulcers, or a solution (gtt. 5 to 30 to the 
ounce [0.3-2.0 : 32.0]), locally applied to 
indolent types, 267 

Ointment of lead carbonate, as a dressing, 
236 

Potassium permanganate (gr. 60 to the 
pint [4.0 : 500 cc] ), as an antiseptic 
wash, 291 

Precipitated carbonate of calcium, as a dry 
dressing, 105 

Silver nitrate, in hard pills, for intestinal 
ulcers, and by injections for rectal and 
crecal ulcers, 264 

Sulphuric acid, sometimes used as an es- 
charotic in slow ulcers, 341 

URiEMIA, 657 
Bromides for convulsions, 658 
Chloral and chloroform for convulsions, 

658 
Elaterium. thought to aid elimination of 

poison by the bowel, 179, 658 
Hypodermoclysis. 65S 
Pilocarpine, a most efficient remedy, 301, 

658 



Strychnine, followed by digitalis, for heart 

failure, 658 
Urethan for convulsions, in large doses, 

658 
Venesection, very useful, 658 

URIC-ACID DIATHESIS. 

Acetate of potassium, 41 

Lime-water, 107 

Piperazine in the dose of 15 grains (1.0) a 

day in 1 pint (500 cc.) of water, 302 
Prescription for prevention of formation of 

calculi, 94 

URTICARIA. 

Ichthvol, ointment, highlv recommended, 
211 

UVULA (RELAXED). 

Capsicum, tincture of, and glycerin, equal 

parts, as a gargle, 116 
Kino, as a gargle, 232 

VARICOCELE. 

Cold water, applied by bidet, highly recom- 
mended, 374 

VARICOSE VEINS. 

Barium chloride, internally and locally ap- 
plied, said to be of value, 83 

Hamamelis, useful internally or injected 
into part, 201 

VITREOUS DISEASES, 658 

Antisyphilitic treatment, if due to syph- 
ilis, 659 

Galvanism, 659 

Leeches, in early stage, if due to inflam- 
mation, 659 

Pilocarpine, hypodermically, 659 

VOMITING, 659 

Acetanilid, very useful, 43, 660 

Bismuth and aconite may be of service, 
prescription for, 660 

Bromide of sodium, with laudanum, as a 
rectal injection, prescription for, 98. 660 

Calomel, 254 

Carbolic acid or creosote, with bismuth, 
useful in acidity and fermentation, pre- 
scription for, 660 

Chloroform, gtt. 1 to 2 (0.05-0.1), in water, 
660 

Cloves, oil of, sometimes controls, 156 

Cocaine or aconite, if due to hyperexcita- 
bility of stomach, 660 

Enemas, partially digested, if vomiting is 
incoercible, 662 

Fowler's solution, gtt. \ to 1 (0.025-0.05), 
every two hours, useful in nausea fol- 
lowing debauch, 661 

Hydrochloric acid, gtt. 5 to 15 (0.3-1.0), in 
water, every two hours, in alcoholic 
nausea, 661 

Hvdrocvanic acid, dilute, gtt. 2 to 6 (0.1- 
* 0.3), in water, 95. 660 

Ice-bag, to nape of neck, lumbar region, or 
epigastrium, 661 

Iodine and carbolic acid, gtt. 1 (0.05) of each 
in 3ij (8.0) of water, 660 

Ipecac, in small doses, if due to gastric de- 
pression, 661 



740 



INDEX OF DISEASES AND REMEDIES. 



Lime-water, added to milk, may relieve 

nausea, 661 
Mustard plaster, over stomach, useful in all 

cases, 661 
Nitro-glycerin, very useful in some cases, 

661 
Nux vomica, if due to gastric depression, 

prescription for, 661 
Oxygen-water, of great service, 285 
Peptonized milk, best food, 661 
Podophyllin, useful in gastric depression 

and hepatic torpor, 305 
Seidlitz powder, often settles stomach, if 

due to constipation, 324 

VOMITING OF PREGNANCY. 

Aconite, as a nervous sedative, 47 

Arsenic, may be tried, 79 

Bromide of potassium, as an effervescing 
draught, or with opium by enema, pre- 
scriptions for, 98 

Cerium oxalate, gr. 2 to 5 (0.1-0.25), in pill, 
every four or five hours, 127 

Cocaine, useful to decrease irritability, 158 

Iodine, tincture of, largely used of late 
with good results, 21b 

Ipecac wine, gtt. 1 (0.05), or powder, gr. 2 
(0.1), useful in some cases, 222 

Menthol, very useful, 289 

WARTS. 

Acetic and salicylic acids combined, 44 
Chromic acid (gr. 100 to the ounce [6.5 : 

32.0]), locally applied, to remove, 146 
Fowler's solution, locally applied, 80 
Glacial acetic acid, useful to remove, 44 
Nitric acid, as a caustic, 267 
Trichloracetic acid, useful, 349 

WHITE SWELLING. 
Iodine, 217 

WHOOPING COUGH, 662 

Aconite or veratrum viride, if vascular en- 
gorgement is excessive, 662 

Amber, oil of, 58 

Amyl nitrite, when paroxysms interfere 
with respiration, 662 

Antipyrine, gr. 2 (0.025-0.15), every five 
hours, probably the best remedy, 662 

Belladonna, tincture of, gtt. i (0.025), thrice 
daily, to child of one or two years, 662 

Benzine, 662 

Bromoform, prescription for, 100, 663 

Bronchitis tent, to modify severity of at- 
tacks, 663 

Carbu retted hydrogen, 662 

Chloral, 131 

Chloride of gold and sodium has been rec- 
ommended, 197 

Chloroform, a few whiffs, if paroxysms in- 
terfere with respiration, 663 

Gelsemium, 193 

Hyoscvamus, probably better than bella- 
donna, 209 



Milk, in small amounts, may overcome 
vomiting following paroxysms, 663 

Monobromated camphor, 111 

Prescription for, 285 

Quinine (gr. 1 to the ounce [0.05 : 32.0]), 
in spray, useful, also of service in ex- 
posed children as a prophylactic, 151 

Besorcin, gtt. 10 (0.65), of a 2 per cent, so- 
lution, internally, or, better, in spray, 
308 

Silver nitrate (gr. \ to 1 to the ounce [0.025- 
0.05 : 32.0J), in spray, used when stom- 
ach is empty, 264 

WORMS, 663 

Aspidium, very efficient against tape-worm, 
prescription for, 83 

Azedarach, a useful remedy against round- 
worms, 83 

Brayera, as an infusion, or fluid extract, 
against round-worms, 663 

Calomel, should follow or precede all drugs 
used for tape- worm, 664 

Castor oil, or a saline purgative, should fol- 
low remedies for round-worms, 664 

Chenopodium, oil of, gtt. 5 to 20 (0.3-1.3), 
on sugar, to remove round-worms, 663 

Chloroform, should not be used against 
tape- worm, 146 

Kamala, drachms 1 to 2 (4.0-8.0), in syrup, 
against tape-worm, 232 

Koosin, gr. 40 (2.6), to adult, against round- 
worms, contraindicated in pregnant 
women, 664 

Pellctierine.gr. 1 to 2 (0.05-0.1), in capsule, 
best remedy against tape-worm, 664 

Pepo, ounce 2 (64.0), in confection, against 
tape-worm, 664 

Quassia injections, preceded by soap and 
water, most useful remedy against seat- 
worms, 307 

Bue, should not be used against round- 
worms, 312 

Bules for diet preceding tamiacides, 663 

Salicylic acid, gr. 8 (0.6), hourly, till gr. 40 
(2.6) are taken, against round-worms, 
or as an injection against seat-worms, 
prescription for, 315 

Santonin, gr. -\ to h (0.016-0.03), in troches, 
for child, against round-worms, <>(>:> 

Spigelia, alone, or, better, with senna, to 
remove round-worms, 663 

Turpentine and castor oil, equal parte, 
efficient, but somewhat dangerous, 
against tape-worm, 351 

WOUNDS. 

Collodion, as an air-tight dressing for small 
wounds, 164 

Potassium permanganate (gr. 20 to 60 to 
the pint [1.3-4.0 : 500 cc.]), as an anti- 
septic wash, 291 

Salicylic acid, 316 

Sozoidol, as an antiseptic and disinfectant 
in diseased wounds, 33'J 



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the great majority of the real contributions of the world to medical science during that period." 
Original Articles, Eeviews and Progress of the Medical Sciences constitute the three main 
departments of this ideal medical monthly. 



COMMUTATION RATE. 

Taken together, The Journal and The News afford to medical readers the ad- 
vantages of the monthly magazine and the weekly newspaper. Thus all the benefits of 
medical periodical literature can be secured at the low figure of $7.50 per annum. 

Subscribers can obtain, at the close of each volume, cloth covers for The Journal (one 
annually), and for The News (one annually), free by mail, by remitting Ten Cents for The 
Journal cover, and Fifteen Cents for The News cover. 



The Medical News Visiting List for 1895 

Is published in four styles, Weekly (dated for 30 patients) ; Monthly (undated, for 120 
patients per month) ; Perpetual (undated, for 30 patients weekly per year) ; and Per- 
petual (undated, for 60 patients weekly per year). The 60-patient Perpetual consists 
of 256 pages of assorted blanks. The first three styles contain 32 pages of important 
data and 176 pages of assorted blanks. Each style is in one wallet-shaped book, leather- 
bound, with pocket, pencil, rubber, and catheter scale. Price, each, $1.25. With thumb- 
letter index, 25 cents extra. 



This list is all that could be desired. It con- 
tains a vast amount of useful information, especi- 
ally for emergencies, and gives good tables of doses 
and therapeutics. — Canadian Practitioner. 

Its compactness and simplicity are such as to 
indicate that the highest point of perfection has 
been reached in works of this class.— University 
Medical Magazine. 



The new issue maintains its previous reputation. 
It adapts itself to every style of book-keeping; 
there is space for all kinds of professional records ; 
it is furnished with a ready reference thumb-letter 
index, and has a most valuable text. — Medical 
Record. 

For convenience and elegance it is not surpass- 
able. — Obstetric Gazette. 



SPECIAL COMBINATIONS WITH THE VISITING LIST, see p. 1. 

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The Medical News Physicians' Ledger. 

Containing 300 pages of fine linen " ledger " paper ruled so that all the accounts of 
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which permits it to lie perfectly flat when opened at any place. Price, $4.00. 

Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street. Philadelphia. 



Medical Dictionary, Quiz Manuals. 



THE STUDENTS' 

DICTIONARY OF MEDIGINE 

AND THE ALLIED SCIENCES, 

COMPRISING THE PEON UNCI ATION, DERIVATION AND FULL EXPLANATION OF MEDICAL 

TERMS; TOGETHER WITH MUCH COLLATERAL DESCRIPTIVE MATTER, 

NUMEROUS TABLES, ETC. 

By ALEXANDER DUANE, M. D., 

Assistant Surgeon to the New York Ophthalmic and Aural Institute; Reviser of Medical Terms for 
Webster's International Dictionary. 

In one square octavo volume of 658 pages. Cloth, $4.25; half leather, $4.50; full 
sheep, $5.00. Just ready. Thumb-letter Index for quick use, 50 cents extra. 



Dr. Duane has spared no time, pains or expense 
in his endeavor to bring before the profession, 
and especially the students of medicine, a book em- 
bodying completeness and explicitness. The 
vocabulary is abundant and its fulness is paral- 
leled by the explanation accorded each word. It 
also contains extensive tables. Each word is fol- 
lowed by its correct pronunciation, a new feature 
in works of this kind, given by means of a simple 
and obvious phonetic spelling. Derivation, the 
greatest aid to memory, is fully treated of, and for 
the convenience of those who do not understand 
Greek, the English letters are substituted for 
those of the Greek in giving the roots of the words 
derived from that language. The author's expe- 
rience as a lexicographer is fully attested by his 
position as Reviser of Medical Terms for Web- 
ster's International Dictionary. We predict that 
this will become a standard and favorite work of 
its class. — Medical Fortnightly. 



From A. L. Loomis, M. D , Professor Pathology and 
Practice of Medicine, Medical Department, Univer- 
sity City of New York, New York. 
It seems to me entirely satisfactory for the pur- 
pose for which it is intended. 
From J. C. Wilson, M. D., Professor of Medicine, 
Jefferson Medical College, Philadelphia. 
It appears to be well suited to the purposes ol 
the medical student, being simple as regards deri- 
vations and pronunciation, explicit yet sufficiently 
comprehensive in definitions, and thoroughly up 
to the times. 

From James T. Whittakee, M. D., Professor Theory 
and Practice of Medicine, Medical College of Ohio, 
Cincinnati, O. 

I find it admirably adapted to the wants of stu- 
dents, and thoroughly modern in every particular 
in which I have taken occasion to consult it. I 
shall certainly recommend it to my class. 



THE STUDENTS' QUIZ SERIES. 

ANEW Series of Manuals, comprising all departments of medical science and practice, 
and prepared to meet the needs of students and practitioners. Written by promi- 
nent medical teachers and specialists in New York, these volumes may be trusted as 
authoritative and abreast of the day. Cast in the form of suggestive questions, and concise 
and clear answers, the text will impress vividly upon the reader's memory the salient 
points of his subject. To the student these volumes will be of the utmost service in pre- 
paring for examinations, and they will also be of great use to the practitioner in recalling 
forgotten details, and in gaining the latest knowledge, whether in theory or in the actual 
treatment of disease. Illustrations have been inserted wherever advisable. Bound in 
limp cloth, and in size suitable for the hand and pocket, these volumes are assured of 
enormous popularity, and are accordingly placed at an exceedingly low price in com- 
parison with their value. For details of subjects and prices see below. 

ANATOMY (Double Number) — By Fred J. 
Beockway, M. D., Assistant Demonstrator of 
Anatomy, College of Physicians and Surgeons, 
New York, and A. O'Malley, M.D., Instructor 



in Surgery, New York Polyclinic. $1.75. 

PHYSIOLOG Y— By P. A. Manning, M. D., 
Attending Surgeon, Manhattan Hosp.,N. Y. $1. 

CHEMISTRY AND PHYSICS — By Joseph 
Stbtjthees, Ph. B., Columbia College School of 
Mines, N.Y., and D. W. Waed, Ph. B., Columbia 
College School of Mines, N. Y., and Chas. H. 
Willmarth, M. S., N. Y. $1. 

HISTOLOGY, PATHOLOCY AND BAC- 
TERIOLOGY— By Bennett S. Beach, M. D., 
Lecturer on Histology, Pathology and Bacte- 
riology, New York Polyclinic. $1. 

MATERIA MEDICA AND THERAPEU- 
TICS— By L. F. Waenee, M.D., Attending 
Physician, St. Bartholomew's Disp., N. Y. $1. 

PRACTICE OF MEDICINE, INCLUDING 
NERVOUS DISEASES— By Ed winT.Dou- 
bleday, M.D., Member N.Y. Pathological Soci- 
ety, and J. D. Nagel, M. D , Member N. Y. 
County Medical Association. SI. 

SURCERY (Double Number)— By Been B. Gal- 
laudet, M. D., Visiting Surgeon, Bellevue 
Hospital, N.Y., and Chaeles Dixon Jones, M. D., 
Assistant Surgeon Out-Patieut Department, 
Presbyterian Hospital, N. Y. $1.75. 



CENITO - URINARY AND VENEREAL 
DISEASE S— By Chaeles H. Chet w ood, M.D., 
Visiting Surgeon, Demilt Dispensary, Dep. of 
Surg, and Gen.-Urin. Dis., New York. $1. 



DISEASES OF THE SKIN— By Chaeles C. 
Ransom, M. D., Assistant Dermatologist, Van- 
derbilt Clinic, New York. $1. 

DISEASES OF THE EYE, EAR, THROAT 
AND NOSE— By Feank E. Millee, M.D., 
Throat Surgeon, Vanderbilt Clinic, New York, 
James P. McEvoy, M.D., Throat Surgeon, Belle- 
vue Hosp., Out-Patient Dep., New York, and 
J. E. Weeks, M. D., Lect. on Ophthal. and 
Otol., Bellevue Hosp., Med. Col., N. Y. $1. 

OBSTETRICS — By Chaele3 W. Hayt, M.D., 
House Physician, Nursery and Child's Hospi- 
tal, New York. U. 

GYNECOLOGY— By G. W. Beatenahl, M. D., 
Assistant in Gynecology, Vanderbilt Clinic, 
New York, and Sinclaie Tousey, M. D., Assist- 
ant Surgeon, Out-Patient Department, Roose- 
velt Hospital, New York. $1. 

DISEASES OF CHILDREN-By C.A.Rhodes, 
M. D., Instructor in Diseases of Children, New 
York Pest-Graduate Medical College. $1. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Dictionaries, 



TWENTY-FIRST EDITION. THOROUGHLY REVISED. 

Dunglison's Dictionary 

OF MEDICAL SCIENCE. 

With the Pronunciation. Accentuation and Derivation of the Terms. 

Containing a full Explanation of the various Subjects and Terms of Anatomy, Physiology* 
Medical Chemistry, Pharmacology, Pharmacy, Therapeutics, Medicine, Hygiene, Dietet- 
ics, Surgery, Ophthalmology, Otology, Laryngology, Dermatology, Gynecology, Obstetrics, 
Pediatrics, Medical Jurisprudence and Dentistry, etc., etc. By Robley Dunglison, 
M. D., late Professor of Institutes of Medicine in the Jefferson Medical College of Phila- 
delphia. New (21st) edition, thoroughly revised and greatly enlarged. With the Pro- 
nunciation, Accentuation and Derivation of the Terms, by Richard J. Dunglison, 
A.M., M. D. In one very large and handsome royal octavo volume of 1191 pages. 
Cloth, $7.00 ; leather, raised bands, $8.00. Thumb-letter Index for quick use, 75 cents extra. 

THIS great medical dictionary, which has been for more than two generations the 
standard of the English- speaking race, is now issued in a thoroughly revised and 
greatly enlarged and improved edition. The new words and phrases aggregate 
by actual count over 44,000. Though the new edition contains far more matter than its 
predecessor, the whole is accommodated within a volume convenient for the hand. 

The revision has not only covered every -word, but it has resulted in a number of 
important new features designed to confer on the work the utmost usefulness, and to make 
it answer the most advanced demands of the times. 

Pronunciation has been introduced throughout by means of a simple and obvious 
system of phonetic spelling. At a glance the proper sound of a word is clearly indicated, 
and thus a most important desideratum is supplied. 

Derivation affords the utmost aid in recollecting the meanings of words, and gives 
the power of analyzing and understanding those which are unfamiliar. It is indicated in 
the simplest manner. Greek words are spelled with English letters, and thus placed at 
the command of those unfamiliar with the Greek alphabet. 

Definitions, the essence of a dictionary, are clear and full, a characteristic in 
which this work has always been preeminent. In this edition much explanatory and 
encyclopedic matter has been added, especially upon subjects of practical importance. Thus 
under the various diseases will be found their symptoms, treatment, etc. ; under drugs their 
doses and effects, etc., etc. A vast amount of information has been clearly and conveniently 
condensed into tables in the alphabet. 

In a word, Dunglison's Medical Dictionary, in its remodelled and enlarged shape, is 
equal to all that the student and practitioner can expect from such a work. 

the existing condition of medical science. Thus, 
under the heading Hernia, besides the definition 
of the condition, a condensed table is given of 
the various forms, and a brief resume is given of 
the therapeutical indications. Under the heading 
Murmurs, besides a description of the various 
forms, a table is given of the significance of the 
murmurs of valvular origin. Under Bacteria the 
leading classifications are recorded, and a para- 
graph is devoted to the question of the determina- 
tion of the pathogenic properties, and another to 
modes of culture of the bacteria.— Tlie Montreal 
Medical Journal, June, 1894. 

So fully have derivations and definitions been 
considered, and so great is the amount of prac- 
tical matter, such as symptoms, treatment and 
prognosis of many of the diseases described, that 
the volume is entitled to be called an encyclo- 
pedia rather than a dictionary. — The Brooklyn 
Medical Journal, June, 1894. 

A thorough system of phonetic spelling gives 
the pronunciation of all words that are not so sim- 
ple as to require no key. — New Orleans Medical and 
Surgical Journal, June,"l894. 



The new " Dunglison" is new indeed. The vast 
amount of new matter and the thoroughness with 
which the work has been brought down to date 
cannot fail to strike even the least observant 
reader. The immense advances made in all 
branches of medical science here find represen- 
tation. A prominent and very useful feature of 
the old book is retained and amplified in this — we 
mean the tables, which recur with great fre- 
quency and represent a vast amount of condensed 
information. In respect to accuracy the book quite 
equals and usually surpasses any of its contempo- 
raries that we are acquainted with. The American 
Journal of the Medical Sciences, Jan., 1894. 

Covering the entire field of medicine, surgery 
and the collateral sciences, its range of usefulness 
can scarcely be measured. Perhaps the most valu- 
able feature in the present work is the addition of 
a vast amount of practical matter. The type is 
commendably clear. — Medical Record, Feb. 24, 1894. 

The new subjects and terms treated are no less 
than forty-four thousand, sufficient in themselves 
to form a large volume. There has been a praise- 
worthy attempt to render the work an epitome of 



The National Medical Dictionary, 

Including English , French, German, Italian and Latin Technical Terms used in 
Medicine and the Collateral Sciences, and a Series of Tables of Useful Data. By John 
S. Billings, M. D., LL. D., Edin. and Harv., D. C. L., Oxon., member of the National 
Academy of Sciences, Surgeon U. S. A., etc. In two very handsome royal octavo volumes 
containing 1574 pages, with two colored plates. Per volume — cloth, $6.00 : leather, $7.00; 
half morocco, marbled edges, $8.50. Subscription only. Address the publishers. 
Apart from the boundless stores of information 



which may be gained by the study of a good diction- 
ary, one is enabled by the work under notice to read 
intelligently any technical treatise in any of the four 



chief modern languages. There cannot be two 
opinions as to the great value of this dictionary as 
a book of ready reference for all sorts and condi- 
tions of medical men. — London Lancet. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Anatomy, Dictionary. 



THIRTEENTH EDITION". 



GRAY'S ANATOMY 



N COLORS OR IN BLACK, 



Anatomy, Descriptive and Surgical, 

BY HENRY GRAY, F, R. S., 

LECTURER ON ANATOMY AT ST. GEORGE'S HOSPITAL, LONDON. 

Edited by T. PICKERING PICK, F.E. C.S., 

Surgeon to and Lecturer on Anatomy at St. George's Hospital, London, Examiner in Anatomy, 
Royal College of Surgeons of England. 

A new American from the thirteenth enlarged and improved London edition. In one 

imperial octavo volume of 1118 pages, with 636 large and elaborate engravings 

on wood. Price, with illustrations in colors, cloth, $7 ; leather, $8. 

Price, with illustrations in black, cloth, §6 ; leather, $7. 

SINCE 1857 Gray's Anatomy has been the standard work used by students of 
medicine and practitioners in all English-speaking races. So preeminent has it 
been among the many works on the subject that thirteen editions have been 
required to meet the demand. This opportunity for frequent revisions has been 
fully utilized and the work has thus been subjected to the careful scrutiny of many of the 
most distinguished anatomists of a generation, whereby a degree of completeness and ac- 
curacy has been secured which is not attainable in any other way. In no former revision 
has so much care been exercised as in the present to provide for the student all the 
assistance that a text-book can furnish. The engravings have always formed a distin- 
guishing feature of this work, and in the present edition the series has been enriched and 
rendered complete by the addition of many new ones. The large scale on which the 
illustrations are drawn and the clearness of the execution render them of unequalled 
value in affording a grasp of the complex details of the subject. As heretofore the name 
of each part is printed upon it, thus conveying to the eye at once the position, extent 
and relations of each organ, vessel, muscle, bone or nerve with a clearness impossible 
when figures or lines of reference are employed. Distinctive colors have been utilized 
to give additional prominence to the attachments of muscles, the veins, arteries 
and nerves. For the sake of those who prefer not to pay the slight increase in cost 
necessitated by the use of colors, the volume is published also in black alone. 

The illustrations thus constitute a complete and splendid series, which will greatly 
assist the student in forming a clear idea of Anatomy, and will also serve to refresh 
the memory of those who may find in the exigencies of practice the necessity of recalling 
the details of the dissecting room. Combining as it does a complete Atlas of Anatomy 
with a thorough treatise on systematic, descriptive and applied Anatomy, the work covers 
a more extended range of subjects than is customary in the ordinary text-books. It not 
only answers every need of the student in laying the groundwork of a thorough medical 
education, but owing to its application of anatomical details to the practice of medicine 
and surgery, it also furnishes an admirable work of reference for the active practitioner. 

We always had a kindly regard for the illustra- have more than one need to ask which one to add. 
tions in Gray, where each organ, tissue, artery, and 
nerve bear their respective names, and in this edi- 
tion color has been worked to advantage in bring- 
ing out the relationship of vessel and nerve. Of late 
years, many works on anatomy have been intro- 
duced to the profession, but as a reference book for 
the practical everyday physician, and as a text-book 
for the student, we think it will be difficult to sup- 
plant Gray. — Buffalo Med. and Surg. Journal. 

It has thoroughly and completely established 
itself as the anatomy, par excellence.— Brooklyn 
Medical Journal, 

It embraces the whole of human anatomy, and 
it particularly dwells on the practical or applied 
part of the subject, so that it forms a most useful, 
intelligible and practical treatise for the student 
and general practitioner. — Dublin Journal of Medi- 
cal Science \ 

In modern times no book on any medical sub- 
ject has held the position of a standard so long as 
Gray's Anatomy. For logical arrangement, clear, 
terse, pointed, and yet full description, it is the 
peer of any work on any scientific subject. A 
pioneer in helpful drawings, it is still in the van 
and leads in every improvement. The physician or 
student who requires but one work on anatomy 
will not need to ask which, nor will those who will 



The work is admitted to be easily first on anatomy 
in any language.— Th eAmer. Practitioner and News. 

Teachers of anatomy are almost unanimous in 
recommending "Gray" as the standard work for 
the student. The illustrations are conceded to be 
the best that have yet been given to the profes- 
sion. In short, Gray's Anatomy is the ideal text- 
book on this subject. — Cleveland Med. Gazette. 

Gray's has been the unvarying standard for 
anatomical study by the vast majority of English- 
speaking medical students for so long that it 
would seem an anomaly to see a student acquire 
such knowledge from some other source. — Medi- 
cal Fortnightly. 

The matchless book of the doctor's or surgeon's 
library is and has been Gray's Anatomy. Since 
1857 it has held the leading place in all colleges as 
a text-book and has been the one central figure in 
the many text-books in anatomy that have claimed 
attention. It is still the standard text-book. — The 
Kansas City Medical Index. 

The careful scrutiny to which it has been sub- 
jected in forty years, and the successive issues of 
thirteen editions have made it what it is to-day, 
the most perfect work of its kind extant.— Uni- 
versity Medical Magazine. 



HOBLYN'S DICTIONARY OF MEDICINE. A Dictionary of the Terms Used in Medicine and the 
Collateral Sciences. By Richaed D. Hobltn, M. D. In one large royal 12mo. volume of 520 double- 
columned pages. Cloth, $1.50; leather, $2.00. 

Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Anatomy, Physiology, 



HUMAN MONSTROSITIES 



BY BARTON C. HIRST, M. D. 

Professor of Obstetrics in the University 
of Pennsylvania. 



and GEORGE A. PIERSOL, M. D. 

Professor of Anatomy and Embryology 
in the University of Pennsylvania. 



Magnificent folio, containing 220 pages of text, illustrated with engravings, and 
39 full- page, photographic plates from nature. In four parts, price, each, $5. Limited 
edition, for sate by subscription only. Address the Publishers. 

We have before us the fourth and last part of 
the latest and best work on human monstrosi- 
ty s. This completes one of the masterpieces of 
American medical literature. Typographically 



and from an artistic standpoint, the work is un- 
exceptionable. In this last and final volume 
is presented the most complete bibliography of 
teratological literature extant. No library will be 
complete without this magnificent work.— Jour- 
nal of the American Medical, Association, 

Altogether, Human Monstrosities is a satisfactory 
production. It will take its place as a standard 
work on teratology in medical libraries, and it 



must always retain the honor of being the first of 
its kind written in the English language. — Trie 
British Medical Journal. 

This work promises to be one for which a place 
must be found in the library of every anatomist, 
pathologist, obstetrician and teratologi&t. It is the 
joint production of an obstetrician, and an embry- 
ologist, and histologist, and this fact makes it 
certain that both the obstetric and anatomical 
sides of the subject will be fully represented and 
described. The book promises to be one of the 
greatest value to the English- speaking medical 
world. — Edinburgh Medical Journal. 



Allen's System of Human Anatomy. 



A System of Human Anatomy, Including Its Medical and Surgical 
Relations. For the use of Practitioners and Students of Medicine. By Harrison 
Allen, M. D., Professor of Physiology in the University of Pennsylvania. With an 
Introductory Section on Histology by E. O. Shakespeare, M. D., Ophthalmologist to 
the Philadelphia Hospital. Comprising 813 double-columned quarto pages, with 380 
illustrations on 109 full page lithographic plates, many of which are in colors, and 241 
engravings in the text. In six Sections, each in a portfolio. Price per Section, $3.50 ; 
also bound in one volume, cloth, $23.00 ; very handsome half Russia, raised bands and 
open back, $25.00. For sale by subscription only. Address the Publishers. 

Holden's Landmarks, Medical and Surgical. 

Landmarks, Medical and Surgical. By Luther Holden, F. E. C. S., 
Surgeon to St. Bartholomew's Hospital, LondoD. Second American from the third and 
revised English ed., with additions by W. W. Keen, M. D., Professor of Artistic Anatomy 
in the Penna. Academy of Fine Arts. In one 12mo. volume of 148 pages. Cloth, $1.00. 

Clarke & Lockwood's Dissector's Manual. 

The Dissector's Manual. By W. B. Clarke, F. E. C.S., and C. B. Lock- 
wood, F. E. C. S., Demonstrators of Anatomy at St. Bartholomew's Hospital Medical 
School, London. In one pocket-size 12mo. volume of 396 pages, with 49 illustrations. 
Limp cloth, red edges, $1.50. See Students' Series of Manuals, page 30. 

Messrs. Clarke and Lockwood have written a book I intimate association with students could have 
that can hardly be rivalled as a practical aid to the given. With such a guide as this, accompanied 
dissector. Their purpose, which is "how to de- by so attractive a commentary as Treves' Surgical 
scribe the best way to display the anatomical Applied Anatomy (same series), no student could 
structure," has been fully attained. They excel in I fail to be deeply and absorbingly interested in the 
a lucidity of demonstration and graphic terseness | study of anatomy. — New Orleans Medical and Sur- 
of expression, which only a long training and gical Journal. 

Treves' Surgical Applied Anatomy. 

Surgical Applied Anatomy. By Frederick Treves, F. E. C. S., Senior 
Demonstrator of Anatomy and Assistant Surgeon at the London Hospital. In one pocket- 
size 12mo. volume of 540 pages, with 61 illustrations. Limp cloth, red edges, $2.00. See 
Students 7 Series of Manuals, p. 30. 

Bellamy's Surgical Anatomy. 

The Student's Guide to Surgical Anatomy : Being a Description of the 
most Important Surgical Kegions of the Human Body, and intended as an Introduction to 
Operative Surgery. By Edward Bellamy, F.B. C. S., Senior Assistant- Surgeon to the 
Charing-Cross Hospital. In one 12mo. vol. of 300 pages, with 50 illus. Cloth, $2.25. 

Wilson's Human Anatomy. 

A System of Human Anatomy, General and Special. By Erasmus 
Wilson, F. R. S. Edited by W. H. Gobrecht, M. P., Professor of General and Surgical 
Anatomy in the Medical College of Ohio. In one large and handsome octavo volume 
of 616 pages, with 397 illustrations. Cloth, $4.00 ; leather, $5.00. 



HARTSHORNE'S handbook of anatomy 
AND PHYSIOLOGY. Second edition, revised. 
12mo., 310 pages, 220 woodcuts. Cloth, $1.75. 

HORNER'S SPECIAL ANATOMY AND HISTOL- 



OGY. Eighth edition. In two octavo volumes 
of 1007 paces, with 320 woodcuts. Cloth. Sfi.on. 
CLELAND'S DIRECTORY FOR THE DISSEC- 
TION OF THE HUMAN BODY. 12mo., 178 pp. 

Cloth, $1.25. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Physics, Physiology, Anatomy, Chemistry. 7 
Draper's Medical Physics. 

Medical Physics. A Text-book for Students and Practitioners of Medicine. 
By John C. Draper, M. D., LL. D., Prof, of Chemistry in the Univ. of the City of 
New York. In one octavo vol. of 734 pages, with 376 woodcuts, mostly original. Cloth, $4. 

culties to be encountered in bringing his subject- 
within the grasp of the average student, and that 
he has succeeded so well proves once more that 
the man to write for and examine students is the 
one who has taught and is teaching them. The 
book is well printed and fully illustrated, and in 
every way deserves grateful recognition. — The 
Montreal Medical Journal. 



No man in America was better fitted than Dr. 
Draper for the task he undertook and he has pro- 
vided the student and practitioner of medicine 
with a volume at once readable and thorough. 
Even to the student who has some knowledge of 
physics this book is useful, as it shows him its 
applications to the profession that he has chosen. 
Dr. Draper, as an old teacher, knew well the diffi- 



Reichert's Physiology.— Preparing. 

A Text-Book on Physiology. By Edward T. Reichert, M. D., Professor 
of Physiology in the University of Pennsylvania, Philadelphia. In one very handsome 
octavo volume of 800 pages, fully illustrated. 

Power's Human Physiology.— Second Edition. 

Human Physiology. By Henry Power, M. B., F. R. C. S., Examiner in 
Physiology, Eoyal College of Surgeons of England. Second edition. In one 12mo. vol. 
of 509 pp., with 68 illustrations. Cloth, $1.50. See Students' Series of Manuals, p. 30. 

Robertson's Physiological Physics. 

Physiological Physics. By J. McGregor Robertson, M. A., M. B., 
Muirhead Demonstrator of Physiology, University of Glasgow. In one 12mo. volume of 
537 pages, with 219 illus. Limp cloth, $2. See Students' Series of Manuals, page 30. 

The title of this work sufficiently explains the ments. It will be found of great value to the 
nature of its contents. It is designed as a man- practitioner. It is a carefully prepared book of 
ual for the student of medicine, an auxiliary to reference, concise and accurate, and as such we 
his text-book in physiology, and it would be particu- heartily recommend it.— Journal of the American 
larly useful as a guide to his laboratory experi- Medical Association, 



Dalton on the Circulation of the Blood. 

Doctrines of the Circulation of the Blood. A History of Physio- 
logical Opinion and Discovery in regard to the Circulation of the Blood. By John C. 
Dalton, M. D., Professor Emeritus of Physiology in the College of Physicians and Sur- 
geons, New York. In one handsome 12mo. volume of 293 pages. Cloth, $2. 



Dr. Dalton's work is the fruit of the deep research 
of a cultured mind, and to the busy practitioner it 
cannot fail to be a source of instruction. It will 
inspire him with a feeling of gratitude and admir- 



ation for those plodding workers of olden times, 
who laid the foundation of the magnificent temple 
of medical science as it now stands. — New Orleans 
Medical and Surgical Journal. 



Bell's Comparative Anatomy and Physiology. 

Comparative Anatomy and Physiology. By F. Jeffrey Bell, M. A., 
Professor of Comparative Anatomy at King's College, London. In one 12mo. vol. of 561 
pages, with 229 illustrations. Limp cloth, $2. See Students 1 Series of Manuals, page 30. 

it the best work in existence in the English 



The manual is preeminently a student's book — 
clear and simple in language and arrangement. 
It is well and abundantly illustrated, and is read- 
able and interesting. On the whole we consider 



language to place in the hands of the medical 

student. — Bristol Medico- Chirurgical Journal. 



Ellis' Demonstrations of Anatomy.— Eighth Edition. 

Demonstrations of Anatomy. Being a Guide to the Knowledge of the 
Human Body by Dissection. By George Viner Ellis, Emeritus Professor of Anatomy 
in University College, London. From the eighth and revised London edition. In one 
very handsome octavo volume of 716 pages, with 249 illus. Cloth, $4.25 ; leather, $5.25. 

Roberts' Compend of Anatomy. 

The Compend of Anatomy. For use in the dissecting-room and in pre- 
paring for examinations. By John B. Roberts, A. M., M. D., Lecturer in Anatomy in 
the University of Pennsylvania. In one 16mo. vol. of 196 pages. Limp cloth, 75 cents. 



WOHLER'S OUTLINES OF ORGANIC CHEM- 
ISTRY. Edited by Fittig. Translated by Ira 
Remsen, M. D., Ph. D. In one 12mo. volume of 
550 pages. Cloth, S3. 

LEHMANN'S MANUAL OF CHEMICAL PHYS- 
IOLOGY. In one octavo volume of 327 pages, 
with 41 illustrations. Cloth, $2.25. 



CARPENTER'S HUMAN PHYSIOLOGY. Edited 
bv Henry Power. In one octavo volume. 

CARPENTER'S PRIZE ESSAY ON THE USE AND 
Abuse of Alcoholic Liquors in Health and Dis- 
ease. With explanations of scientific words. Small 
12mo. 178 pages. Cloth, 60 cents. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street Philadelphia. 



8 



Physiology— (Continued), Chemistry. 



Foster's Physiology.— Fifth American Edition. 

Text-Book of Physiology. By Michael Foster, M. D., F. B. S., Prelec- 
tor in Physiology and Fellow of Trinity College, Cambridge, England. Fifth and 
enlarged American from the fifth and revised English edition, with notes and additions. 
In one handsome octavo vol. of 1064 pages, with 316 illus. Cloth, $4.50; leather, $5.50. 



It is unquestionably the standard textbook on 
physiology for students and practitioners. The 
moderate price of this well-issued book at once 
shows how popular the work has become. The 
style is plain enough even for the beginner; the 
details are sufficient for the teacher; and the 
manner of dealing with the topics is well-ar- 
ranged for the advantage of the practitioner.— 
Virginia Medical, Monthly, January, 1894. 

Foster's Physiology is an accepted text-book in 
almost every medical college in this country, and 
already commended to all medical students. For 
the physician who aims to keep abreast of all that 
is new that is true in medicine, a work like this 
is a necessity. The illustrations are excellent and 
are well printed. — The Cincinnati Lancet-Clinic, 
June 9, 1894. 

One cannot read a single chapter without being 



impressed with the care that the author has be- 
stowed upon it. Apparently nothing that is known 
up to the present year concerning vital processes 
has escaped his painstaking attention. The details 
receive the fullest consideration. The additions 
which have been made to this last edition are 
caused by an effort to explain more fully ano at 
greater length what seemed to be the most funda- 
mental and important topics. The publishers 
have subjected it to the searching revision of one 
of the foremost American professors of physio- 
logy. We have nothing but words of the highest 
praise for the classical and thorough manner in 
which the work is written, as well as for the liber- 
ality of the publishers for selling such a large 
work, and one which must necessarily be very 
costly to produce, for an extremely moderate 
price. — The Canada Medical Record, March, 1894. 



Dalton's Physiology.— Seventh Edition. 

iA Treatise on Human Physiology. Designed for the use of Students 
and Practitioners of Medicine. By John C. Dalton, M. D., Professor of Physiology in 
the College of Physicians and Surgeons, New York, etc. Seventh edition, thoroughly 
revised and rewritten. In one very handsome octavo volume of 722 pages, with 252 beau- 
tiful engravings on wood. Cloth, $5.00 ; leather, $6.00. 



From the first appearance of the book it has 
been a favorite, owing as well to the author's 
renown as an oral teacher as to the charm of 
simplicity with which, as a writer, he always 
succeeds in investing even intricate subjects. 
It must be gratifying to him to observe the fre- 
quency with which his work, written for students 
and practitioners, is quoted by other writers on 
physiology. This fact attests its value, and, in 
great measure, its originality. It now needs no 
such seal of approbation, however, for the thou- 
sands who have studied it in its various editions 



have never been in any doubt as to its sterling 
worth.— N. Y. Medical Journal. 

Professor Dalton's well-known and deservedly- 
appreciated work has long passed the stage at 
which it could be reviewed in the ordinary sense. 
The work is eminently one for the medical prac- 
titioner, since it treats most fully of those branches 
of physiology which have a direct bearing on the 
diagnosis and treatment of disease. The work is 
one"which we can highly recommend to all our 
readers.— Dublin Journal of Medical Science. 



Chapman's Human Physiology. 

A Treatise on Human Physiology. By Henry C. Chapman, M. E>., 
Professor of Institutes of Medicine in the Jefferson Medical College of Philadelphia. 
In one octavo volume of 925 pages, with 605 engravings. Cloth, $5.50; leather, $6.50. 



It represents very fully the existing state of 
physiology. The present work has a special value 
to the student and practitioner as devoted more 
to the practical application of well-known truths 
which the advance of science has given to the 
profession in this department, which may be con- 
sidered the foundation of rational medicine. — Buf- 
falo Medical and Surgical Journal. 

Matters which have a practical bearing on the 
practice of medicine are lucidly expressed; tech- 



nical matters are given in minute detail; elabo- 
rate directions are stated for the guidance of stu- 
dents in the laboratory. In every respect the 
work fulfils its promise, whether as a complete 
treatise for the student or for the physician ; for 
the former it is so complete that he need look no 
farther, and the latter will find entertainment and 
instruction in an admirable book of reference. — 
North Carolina Medical Journal. 



Schofield's Elementary Physiology. 

Elementary Physiology for Students. By Alfred T. Schofield, 
M. D., Late House Physician London Hospital. In one 12mo. volume of 380 pages, with 
227 engravings and 2 colored plates containing 30 figures. Cloth, $2.00. 



Frankland & Japp's Inorganic Chemistry. 

Inorganic Chemistry. By E. Frankland, D. C. L., F. B. S., Professor of 
Chemistry in the Normal School of Science, London.,and F. B. Japp, F. I. C, Assistant 
Professor of Chemistry in the Normal School of Science, London. In one handsome 
octavo volume of 677 pages with 51 woodcuts and 2 plates. Cloth, $3.75 ; leather, $4.75. 



Clowes 7 Qualitative Analysis.— Third Edition. 

An Elementary Treatise on Practical Chemistry and Qualitative 
Inorganic Analysis. Specially adapted for use in the Laboratories of Schools and 
Colleges and by Beginners. By Frank Clowes, D. Sc, London, Senior Science-Master 
at the High School, Newcastle-under- Lyme, etc. Third American from the fourth and 
revised English edition. la one 12mo. vol. of 387 pages, with 55 illus. Cloth, $2.50. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Chemistry — (Continued). 



Simon's Chemistry.— New (5th) Edition. Just Ready. 

Manual of Chemistry. A Guide to Lectures and Laboratory work for Begin- 
ners in Chemistry. A Text-book specially adapted for Students of Pharmacy and Medi- 
cine. By W. Simon, Ph. D., M. D., Professor of Chemistry and Toxicology in the College 
of Physicians and Surgeons, Baltimore, and Professor of Chemistry in the Maryland Col- 
lege of Pharmacy. New (5th) edition. In one 8vo. vol. of 501 pp., with 44 woodcuts and 
8 colored plates illustrating 64 of the most important chemical tests. Cloth, $3.25 



The exhaustion of the very large fourth edition 
in less than two years indicates the leading posi- 
tion achieved by Professor Simon's Chemistry as a 
text-book in medical and pharmaceutical colleges. 
It furnishes an admirable selection of material 
bearing upon the laws and phenomena of chem- 
istry. As an aid to laboratory work a number of 
experiments have been added. Physicians as well 
as students will aopreciate the value of the colored 
plates of reactions, which give a permanent and 



referred to this series of colors and color changes. 
The new edition has been most carefully revised 
in accordance with the advance of science and in 
order to bring it into comp'ete harmony with the 
new Pnarmacopoeia. All chemicals mentioned in 
the last issue of that work are included. Special 
care has been taken to detail the most modern 
methods for chemical examination in clinical 
diagnosis. The author's experience as a physician 
and as a teacher of medical and pharmaceutical 



accurate series of standards for comparison of l students is reflected in the special adaptation of 
tests, a matter not susceptible of satisfactory his book to the needs of all concerned with the 
explanation in words. In medical practice im- applications of chemistry to the art of healing.— 
portant pathological and toxicological questions Southern Practitioner, April, 1895. 
depending on the test-tube may with certainty be 

Attfield's Chemistry.— New (14th) Edition. Just Ready. 

Chemistry, General, Medical and Pharmaceutical; Including the 
Chemistry of the U. S. Pharmacopoeia. A Manual of the General Principles of the 
Science, and their Application to Medicine and Pharmacy. By John Attfield, M. A., 
Ph.D., F. I.C., F. R. S., etc., Professor of Practical Chemistry to the Pharmaceutical 
Society of Great Britain, etc. Fourteenth edition, specially revised by the Author 
for America, to accord with the new U. S. Pharmacopoeia. In one 12mo. volume of 794 
pages, with 88 illustrations. Cloth, $2.75 ; leather, $3.25. 

It occupies a unique position, 



Attfield is the most widely known and the most 
extensively used chemistry that has ever been 
published in the English language. This manual 
is a systematic exponent of the general truths of 
chemistry, and is written mainly for pupils, assist: 
ants and principals engaged in medicine and 
pharmacy. It will be found equally useful as a 
reading book for students having no opportunities 
of attending lectures or performing experiments, 
or, on the other hand, as a text-book for college 
pupils. Attfield's Chemistry can lay claim to unex- 
ampled popularity. — Charlotte Med. Jour., Oct., 1894. 

This work has long been a standard, and will need 



no introduction. 

for, although it is a complete manual of chemistry, 
it has been arranged and especially adapted to the 
needs of the physician and pharmacist. The work 
is made to correspond with the last edition of the 
United States Pharmacopoeia. The present edition 
contains such alterations and additions as seemed 
necessary for the demonstration of the latest 
developments of chemical principles and the 
latest applications of chemistry to pharmacy. 
The fact that this work now appears in its four- 
teenth edition is abundant proof that it supplies 
a distinct want.— Univ. Med. Magazine, Dec, 1894. 



Fownes' Chemistry.— Twelfth Edition. 

A Manual of Elementary Chemistry; Theoretical and Practical. By 
George Fownes, Ph. D. Embodying Watts' Physical and Inorganic Chemistry. New 
American, from the twelfth English edition. In one large royal 12mo. volume of 1061 
pages, with 168 engravings and a colored plate. Cloth, $2.75 ; leather, $3.25. 



Fownes' Chemistry has been a standard text- 
book upon chemistry for many years. Its merits 
are very fully known by chemists and physicians 
everywhere in this country and in England. As 
the science has advanced by the making of new 
discoveries, the work has been revised so as to 
keep it abreast of the times. It has steadily 
maintained its position as a text-book with medi- 



cal students. In this work are treated fully : Heat, 
Light and Electricity, including Magnetism. The 
influence exerted by these forces in chemical 
action upon health and disease, etc., is of the most 
important kind, and should be familiar to every 
medical practitioner. We can commend the 
work as one of the very best text-books upon 
chemistry extant. — Cincinnati Med. News. 



Bloxam's Chemistry.— Fifth Edition. 



Chemistry, Inorganic and Organic. By Charles L. Bloxam, Professoi 
of Chemistry in King's College, London. .New American from the fifth London 
edition, thoroughly revised and. much improved. In one very handsome octavo 
volume of 727 pages, with 292 illustrations. Cloth, $2.00 ; leather, $3.00. 



Comment from us on this standard work is al- 
most superfluous. It differs widely in scope and 
aim from that of Attfield, and in its way is equally 
beyond criticism. It adopts the most direct meth- 
ods in stating the principles, hypotheses and facts 
of the science. Its language is so terse and lucid, 
and its arrangement of matter so logical in se- 
quence that the student never has occasion to 



complain that chemistry is a hard study. Much 
attention is paid to experimental illustrations of 
chemical principles and phenomena, and the 
mode of conducting these experiments. The book 
maintains the position it has always held as one of 
the best manuals of general chemistry in the Eng- 
lish language. — Detroit Lancet. 



Luff's Manual of Chemistry. 

A Manual of Chemistry. For the use of students of medicine. By Arthur 
P. Ltjef, M. L\, B. Sc, Lecturer on Medical Jurisprudence and Toxicological Chemistry, 
St. Mary's Hospital Medical School, London. In one 12mo. vol. of 522 pages, with 36 
engravings. Cloth, $2.00. See Students' Series of Manuals, page 30. 

Greene's Manual of Medical Chemistry. For the use of Students. By 
"Wtlltam H. Greene, M. D., Demonstrator of Chemistry in the University of Pennsyl- 
vania. In one 12mo. volume of 310 pages, with 74 illus. Cloth, $1.75. 

Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



10 Chemistry — (Continued), Pharmacy. 

Caspari's Pharmacy.— In Press for Early Issue. 

A Text-Book on Pharmacy, for Students and Pharmacists. By 

Charles Caspari, Jr , Ph. G., Professor of the Theorv and Practice of Pharmacy in the 
Maryland College of Pharmacy, Joint Editor of The National Dispensatory, fifth edition. 
In one very handsome octavo volume, richly illustrated. 

The author is widely known as joint editor of The National Dispensatory (see next page) 
and as Professor of Pharmacy in one of the foremost pharmaceutical colleges in America. 
He is therefore exceptionally qualified to prepare a work of the highest merit, both as a 
text-book for students, and as a practical reference for pharmacists in all the multifarious 
details of their operations. Modern in every particular ; convenient in size through avoid- 
ance of obselete and unnecessary matter, richly illustrated and issued at a reasonable price, 
Caspari's Pharmacy is equally assured of immediate popularity with pharmacists and of 
adoption as the standard text-book for pharmaceutical students. 

Vaughan & Novy on Ptomaines and Leucomaines — New Ed. 

Ptomaines, Leucomaines and Bacterial Proteids ; or the Chemi- 
cal Factors in the Causation of Disease. By Victor C. Vaughan, Ph. D., 
M. D., Professor of Physiological and Pathological Chemistry, and Associate Professor of 
Therapeutics and Materia Medica in the University of Michigan, and Frederick G. 
Novy, M. D., Instructor in Hygiene and Physiological Chemistry in the University of 
Michigan. New (third) edition. In one 12mo. volume of about 400 pages. In press. 
A notice of the previous issue is appended. 

and sanitarian. It contains information which 



This book is one that is of the greatest import- 
ance, and the modern physician who accepts 
bacterial pathology cannot have a complete 
knowledge of this subject unless he has carefully 
perused it. To the toxicologist the subject is 
alike of great import, as well as to the hygienist 



is not easily obtained elsewhere, and which is 
of a kind that no medical thinker should be 
without.— The American Journal of the Medical 
Sciences. 



Remsen's Theoretical Chemistry.— Fourth Edition. 

Principles of Theoretical Chemistry, with special reference to the Con- 
stitution of Chemical Compounds. By Ira Eemsen, M. D., Ph. D., Professor of Chem- 
istry in the Johns Hopkins University, Baltimore. Fourth and thoroughly revised edi- 
tion. In one handsome royal 12mo. volume of 325 pages. Cloth, $2.00. 

The fourth edition of Professor Remsen's well- I lation into German and Italian speaks for its ex- 
known book comes again, enlarged and revised, j alted position and the esteem in which it is held 
Each edition has enhanced its value. We may say by the most prominent chemists. We claim for 
without hesitation that it is a standard work on this little work a leading place in the chemical 
the theory of chemistry, not excelled and scarcely j literature of this country. — The American Journal 
equalled by any other in any language. Its trans- | of the Medical Sciences. 



Charles' Physiological and Pathological Chemistry. 

The Elements of Physiological and Pathological Chemistry. A 

Handbook for Medical Students and Practitioners. Containing a general account of 
Nutrition, Foods and Digestion, and the Chemistry of the Tissues, Organs, Secretions and 
Excretions of the Body in Health and in Disease. Together with the methods for pre- 
paring or separating their chief constituents, as also for their examination in detail, and 
an outline syllabus of a practical course of instruction for students. By T. Cranstoun 
Charles, M. D., F. R. S., M. S., formerly Assistant Professor and Demonstrator of Chem- 
istry and Chemical Physics, Queen's College, Belfast. In one handsome octavo volume 
of 463 pages, with 38 woodcuts and 1 colored plate. Cloth, $3.50. 

Dr. Charles is fully impressed with the impor- nowadays. Dr. Charles has devoted much space 

tance and practical reach of his subject, and he to the elucidation ot urinary mysteries. He does 

has treated it in a competent and instructive man- this with much detail, and yet in a practical and 

ner. We cannot recommend a better book than intelligible manner. In fact, the author has filled 

the present. In fact, it fills a gap in medical text- his book with many practical hints.— Medical Eee- 

books, and that is a thing which can rarely be said ord. 

Hoffmann and Powers' Analysis. 

A Manual Of Chemical Analysis, as applied to the Examination of Medi- 
cinal Chemicals and their Preparations. Being a Guide for the Determination of their 
Identity and Quality, and for the Detection of Impurities and Adulterations. For the 
use of Pharmacists, Physicians, Druggists and Manufacturing Chemists, and Pharmaceu- 
tical and Medical Students. By Frederick Hoffmann, A. M., Ph. D., Public Analyst to 
the State of New York, and Frederick B. Power, Ph. D., Professor of Analytical Chem- 
istry in the Philadelphia College of Pharmacy. Third edition, entirely rewritten and 
much enlarged. In one octavo volume of 621 pages, with 179 illustrations. Cloth, $4.25. 

Ralfe's Clinical Chemistry. 

Clinical Chemistry. By Charles H. Kadfe, M. D., F. B. C. P., Assistant 
Physician at the London Hospital. In one pocket-size 12mo. volume of 314 pages, 
with 16 illus. Limp cloth, red edges, $1.50. See Students' Series of Manuals, page 30. 

Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Pharmacy, flateria fledica, Therapeutics. 11 

NEW AND THOROUGHLY REVISED EDITION. 

The National Dispensatory. 

Containing the Natural History, Chemistry, Pharmacy, Actions and Uses of Medi- 
cines, including those recognized in the Pharmacopoeias of the United States, Great 
Britain and Germany, with numerous references to the French Codex. By Alfred 
Stieee, M. D., LL.D., Professor Emeritus of the Theory and Practice of Medicine and of 
Clinical Medicine in the University of Pennsylvania, John M. Maeoh, Phar. D., late 
Professor of Materia Medica and Botany in Philadelphia College of Pharmacy, Secretary 
to the American Pharmaceutical Association, Charles Caspari, Jr., Ph. G., Professor 
of Pharmacy in the Maryland College of Pharmacy, Baltimore, and Henry C. C. Maisch, 
Ph. G., Ph. D. New (fifth) edition, thoroughly revised in accordance with the new U. S. 
Pharmacopoeia (Seventh Decenoial Revision, 1894). In one magnificent imperial octavo 
volume of 1910 pages, with 320 engravings. Cloth, $7.25, leather, $8.00. With Ready 
Reference Thumb letter Index, cloth, $7.75 ; leather, $8.50. 

ON the first appearance of The National Dispensatory fifteen years ago it was at once 
recognized by the pharmaceutical and medical professions as satisfying the need 
for a work affording all necessary information upon its subject, with authoritative 
accuracy, and with a completeness and convenience attainable only by the exclusion of 
obsolete matter. Its success in filling this want is fully attested by the rapid demand for 
five editions, and the opportunity thus afforded has been well used in successive revisions, 
each placing it abreast of the day and maintaining the characteristics which had won for 
it a leading position. 

Of all its issues the present embodies the results of the most exhaustive revision. 
The sweeping changes in the new United States Pharmacopoeia are thoroughly incorpor- 
ated, with official authorization of the Committee of Revision, and full use has been made 
of all valuable material in the latest issues of foreign Pharmacopoeias. The volume is 
accordingly rich in pharmaceutical and chemical information, with data, formulas, tables, 
etc., gathered from all official sources, but this constitutes only a single department of its 
usefulness. As an encyclopaedia of the latest and best therapeutical knowledge it deals 
not only with all official drugs, but also with all the new synthetic remedies of value 
and with the unofficial preparations now so largely in use. Pharmacists will appreciate 
its systematic descriptions of the materia medica, its clear explanations of chemical and 
pharmaceutical processes and tests, and its illustrations of important drugs and of the 
most improved apparatus. Physicians will readily perceive the indispensable assistance 
offered by its authoritative statements as to the efficacy of drugs in the light of the most 
recent medical advances. Arranged alphabetically in the text, this information is 
placed most suggestively at command by the recommendations grouped under the various 
Diseases in the Therapeutical Index. Together with the General Index this covers more 
than one hundred treble-columned pages containing 25,000 references. The immensity 
of detail compiised in this single volume of 1900 pages is thus most forcibly indicated. 
Though the present edition contains far more matter than its predecessor it is maintained 
at the same price in view of the ever- increasing demand. Weights and Measures are 
given in both Ordinary and Metric Systems. 

In brief the new edition of The National Dispensatory is presented to the medical 
and pharmaceutical professions as the equivalent of a whole library of pharmaceutical and 
therapeutic information; it is the standard of accuracy, the embodiment of completeness 
without inconvenient bulk, and a marvel of cheapness owing to the widespread demand 
for it as the authority. 



The careful examination of this large volume 
will strike the reader with surprise at the great 
number of new articles added, and the amount of 
useful and accurate information regarding their 
properties, methods of preparation and therapeu- 
tical effects. The large number of new articles 
containing all the latest synthetic remedies and 
unofficial remedies, compass the entire range of 
available information in the line of the work. A 
number of very complete tables together with all 
the official re-agents and solutions for qualitative 
and quantitative tests, appear in the appendix. 
Altogether this work maintains its previous high 
reputation for accuracy, practical uselulness and 
encyclopaedic scope, and is indispensable alike to 
the pharmacist and physician. Every druggist 
knows of it and uses it, and almost every physi- 
cian properly consults it when desirous of settling 
all doubtful questions regarding the properties, 
preparation and uses of drugs. — Medical Record. 

The descriptions of materia medica are clear, 
thorough and systematic, as are also the explana- 
tions of chemical and pharmaceutical processes 
and tests. The therapeutical portion has been re- 



vised with equal care and the statements of the 
action and uses have been arranged not only 
alphabetically under the various drugs, but for 
practical medical usefulness have also been placed 
at the instant command of those seeking infor- 
mation in the treatment of special diseases by 
being arranged under the various diseases in a 
therapeutical index. The readiness with which 
any of the vast amount of information contained 
in this work is made available is indicated by the 
twenty-five thousand references in the two in- 
dexes at the end of the volume. — Boston Medical 
and Surgical Journal. 

It is the official guide for the medical and phar- 
maceutical professions.— Buffalo Medical and Sur- 
gical Journal. 

The book is recommended most highly as a 
book of reference for the physician and is invalu- 
able to the druggist in his every-day work.— The 
Therapeutic Gazette. 

This edition of the Dispensatory should be recog- 
nized as a national standard. — The North American 
Practitioner. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



12 Therapeutics, flateria fledica — (Continued). 
Hare's Text-Book of Practical Therapeutics.— Fourth Edition. 

A Text-Book of Practical Therapeutics ; With Especial Preference to 
the Application of Eemedial Measures to Disease and their Employment upon a Rational 
Basis. By Hobae/t Amory Hare, M. D., Professor of Therapeutics and Materia Medica 
in the Jefferson Medical College of Philadelphia ; Sec. of Convention for Revision of U. S. 
Pharmacopoeia of 1890. With special chapters by De,s. G. E. de Schweinitz, Edward 
Martin and Barton C. Hirst. New (4th) and revised edition. In one octavo volume 
of 740 pages. Cloth, $3.75 ; leather, $4.75. 

We deem the portion of the work descriptive of 
remedies admirable by reason of the clearness 
and conciseness with which it is written. The 
descriptions of diseases, though exceedingly- 
brief, are nevertheless sufficiently explicit and so 
expressed as to render the work a very practical 
text-book, and also one which will serve prac- 
titioners for ready reference. The methods of 
treatment are at once sensible and practical. The 
more experienced the practitioner who turns to 
this book for reference, the more sure will be the 
approval of the methods of treatment here pro- 
posed. — The North American Practitioner, Oct., '94. 

The fact that the fourth edition of this work has 
appeared within four years attests its value to the 



practical needs of every-day medicine com- 
mended it from the first to the progressive and 
working therapeutist. It is not only knowing 
what to give, but when and where to give, and 
how the drug will act in given conditions, that 
makes one a scientific practitioner rather than an 
ignorant empiric. The book in such respects 
supplies every need. The author is well known 
as a progressive therapeutist, and it goes without 
saying that all the new or valuable drugs receive 
their full share of attention, and it is a great deal 
to say in this, as with other features, that the book 
is up-to-date in everything pertaining to the prac- 
tical therapeutical needs of the practitioner. The 
work has also been revised in such a way as to 
general practitioner, and its appreciation by the j make it uniform with the United States Pharma- 
medical student. Its wide application to the I copceia. — Medical Record, October 20, 1894. 



A System of Practical Therapeutics 

BY AHERICAN AND FOREIGN AUTHORS. 
Edited by HOBART AriORY HARE, n. D. 

Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. 

In a series of contributions by seventy-eight eminent authorities. In three large 
octavo volumes of 3544 pages, with 434 illustrations. Price, per volume : Cloth, $5.00 ; 
leather, $6.00 ; half Russia, $7.00. For sale by subscription only. Address the Publishers. 
Full prospectus free to any address on application. 

The various divisions have been elaborated by | is the treatment of disease, and a work which con- 
men selected in view of their special fitness. In ! tributes to its successful management is to be 
every case there is to be found a clear and concise j looked upon as of vast use to humanity. It can- 
description of the disease under consideration, I not be denied that therapeutic resources, whether 
corresponding with the most recent and well- the treatment be confined to the mere administra- 
established views of the subject. In treating of tion of drugs, or allowed its more extended appli- 
the employment of remedies and therapeutical | cation to the management of disease, have so 
measures, the writers have been singularly happy . greatly multiplied within the last few years as to 



in giving in a definite way the exact methods em- 
ployed and the results obtained, both by them- 
selves and others, so that one might venture with 
confidence to use remedies with which he was 
previously entirely unfamiliar. The practitioner 
could hardly desire a book on practical thera- 
peutics which he could consult with more interest 
and profit.— The North American Practitioner. 

The scope of this work is beyond that of any 
previous one on the subject. The goal, after all, 



render previous treatises of little value. Herein 
will be found the great value of flare's encyclo- 
pedic work, which groups together within a single 
series of volumes the most modern methods 
known in the management of disease. We can- 
not commend Hare's System of Practical Thera- 
peutics too highly; it stands out first and foremost 
as a work to be consulted by authors, teachers, 
and physicians throughout the world. — Buffalo 
Medical and Surgical Journal. 



Maisch's Materia Medica.— New (6th) Edition. 

A Manual of Organic Materia Medica; Being a Guide to Materia Medica 
of the Vegetable and Animal Kingdoms. For the Use of Students, Druggists, Pharmacists 
and Physicians. By John M. Maisch, Phar. D., Prof, of Materia Medica and Botany in 
the Philadelphia College of Pharmacy. New (sixth) edition, thoroughly revised. In one 
very handsome 12mo. volume of 544 pages, with 270 engravings. Cloth, $3.00. 
A notice of the previous edition is appended. 
We have nothing but praise for Professor 



Maisch's work. It presents no weak point, even 
for the most severe critic. The book fully sustains 
the wide and well-earned reputation of its popular 
author. After a careful perusal of the book, we 
do not hesitate to recommend Maisch's Manual 



of Organic Materia Medica as one of the best, if not 
the best work on the subject thus far published. 
Its usefulness cannot well be dispensed with, and 
students, druggists, pharmacists and physicians 
should all possess a copy of such a valuable 
book.— Medical News. 



Edes' Therapeutics and Materia Medica. 

A Text-Book of Therapeutics and Materia Medica. Intended for the 
Use of Students and Practitioners. By Eobert T. Edes, M. D., Jackson Professor of 
Clinical Medicine in Harvard University. Octavo, 544 pp. Cloth, $3.50 ; leather, $4.50. 



COHEN'S HANDBOOK OF APPLIED THERA- 
PEUTICS. Being a Study of Principles Applic- 
able and an Exposition of Methods Employed 
in the Management of the Sick. By Solomon 
Solis-Cohen, M. D., Professor of Clinical Medi- 
cine and Applied Therapeutics in the Philadel- 
phia Polyclinic. In one large 12mo. volume, 



with illustrations. Preparing. 
STILLE'S THERAPEUTICS AND MATERIA 
MEDICA. A Systematic Treatise on the Action 
and Uses of Medicinal Agents, including their 
Description and History. Fourth edition, re- 
vised and enlarged. In two octavo volumes, coi> 
taining 1936 pages. Cloth, $10.00 ; leather, $12.00. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Practice of fledicine. 



13 



NEW (SEVENTH) EDITION. 



FLINTS PRACTICE OF MEDICINE 



A Treatise on the Principles and Practice of Medicine. 

for the use of Students and Practitioners of Medicine. By Austin Flint, M. D., LL. D., 
Professor of the Principles and Practice of Medicine and of Clinical Medicine in Belle- 
vue Hospital Medical College, N. Y. New (7th) edition, thoroughly revised by Fred- 
erick P. Henry, M. D., Professor of Principles and Practice of Medicine in the 
Woman's Medical College of Pennsylvania, Philadelphia. In one very handsome octavo 
volume of 1143 pages, with illustrations. Cloth, $5.00 ; leather, $6.00. 



Its peculiar excellences and its breadth of con- 
ception have made it a recognized authority from 
the time its first edition appeared. The author 
was a born teacher, an indefatigable observer, a 
painstaking worker and a thorough medical phi- 
losopher. His clinical pictures of diseases are 
models of graphic description, minuteness of 
detail and breadth of treatment This may appear 
to be high praise, but the work has so well earned 
its leading place in medical literature that but one 
view can be expressed concerning its general 
character as a text-book. The editor has done his 
part in bringing it up to date, not only in refer- 
ence to treatment and the adaptation of the newer 
remedies, but has made numerous additions in 
the shapeofthe newly discovered forms of disease, 
and has elaborated much in the commoner forms 
which the recent advances have made necessary. 
The element of treatment is by no means ne- 
glected ; in fact, by the editor a fresh stimulus is 
given to this necessary department by a compre- 
hensive study of all the new and leading thera- 
peutic agents.— Medical Record, October 20, 1894. 



Among the large number of new books upon the 
practice of medicine which have been presented 
to the profession within the last few years, there 
is none which will stand better in the present or 
in the future than the seventh edition of this 
book. It has been a characteristic of Dr. Flint's 
book that its descriptions of clinical cases and of 
the practical side of diseases have always been 
wonderfully true to life. Further than this, we 
think the profession is to be congratulated that 
the publishers, in obtaining an editor, chose one 
so peculiarly well qualified to revise and bring up 
to date those articles in connection with which 
the greatest progress has been made in medical 
study, for Dr. Henry represents at once that side 
of professional life which appreciates all that is 
good and at the same time is not so optimistic as 
to swallow in addition much that is bad. We be- 
lieve that the profession, the teachers, and the 
students of the country will appreciate this volume 
as being one of the best all-around text-books 
which they can obtain. — Therapeutic Gazette, Oc- 
tober 15, 1894. 



Hartshorne's Essentials of Practice.— Fifth Edition. 

Essentials of the Principles and Practice of Medicine. A Handbook 
for Students and Practitioners. By Henry Hartshorne, M. D., LL. D., lately Professor 
of Hygiene in the University of Pennsylvania. Fifth edition, thoroughly revised and 
rewritten. In one 12mo. vol. of 669 pages, with 144 illus. Cloth, $2.75 ; half leather, $3. 



Farquharson's Therapeutics and Materia Medica — 4th Ed. 

A Guide to Therapeutics and Materia Medica. By Kobert Far- 
qtjharson, M. D., F. E. C. P., LL. L>., Lecturer on Materia Medica at St. Mary's Hospi- 
tal Medical School, London. Fourth American, from the fourth English edition. 
Enlarged and adapted to the U. S. Pharmacopoeia. By Frank Woodbury, M. D., Pro- 
fessor of Materia Medica and Therapeutics and Clinical Medicine in the Medico- Chi- 
rurgical College of Philadelphia. In one handsome 12mo. vol. of 581 pp. Cloth, $2.50. 



It may correctly be regarded as the most modern 
work of its kind. It is concise, yet complete. 
Containing an account of all remedies that have 
a place in the British and United States Pharma- 



copoeias, as well as considering all non-official but 
important new drugs, it becomes in fact a miniature 
dispensatory. — Pacific Medical Journal. 



Bruce's Materia Medica and Therapeutics.— Fifth Edition. 

Materia Medica and Therapeutics. An Introduction to Rational Treat- 
ment. By J. Mitchell Bruce, M. D., F. E. C. P., Physician and Lecturer on Materia 
Medica and Therapeutics at Charing-Cross Hospital, London. Fifth edition. In one 
12mo. volume of 591 pages. Cloth, $1.50. See Students' Series of Manuals, page 30. 



The pharmacology and therapeutics of each drug 
are given with great fulness, and the indications for 
its rational employment in the practical treatment 
of disease are pointed out. The Materia Medica 
proper contains all that is necessary for a medical 
student to know at the present day. The third 



part of the book contains an outline of general 
therapeutics, each of the symptoms of the body 
being taken in turn, and the methods of treat- 
ment illustrated. A lengthy notice of a book so well 
known is unnecessary. — Med. Chronicle. 



FLINT'S PRACTICAL TREATISE ON THE 
DIAGNOSIS, PATHOLOGY AND TREATMENT 
OF DISEASES OF THE HEART. Second re- 
vised and enlarged edition. In one octavo vol- 
ume of 550 pages, with a plate. Cloth, $4. 

FLINT ON PHTHISIS In one octavo volume 
of 442 pages. Cloth, $3.50. 

FLINT'S ESSAYS ON CONSERVATIVE MEDI- 
CINE AND KINDRED TOPICS. In one very 
handsome royal 12mo. volume of 210 pages. 
Cloth, $1.38. 

LYONS' TREATISE ON FEVER. In one 8vo. 
volume of 354 pages. Cloth, $2.25 

HUDSON'S LECTURES ON THE STUDY OF 



FEVER. In one octavo volume of 308 pages. 
Cloth, $2.50. 

LA ROCHE ON YELLOW FEVER, in its Histori- 
cal, Pathological, Etiological and Therapeutical 
Relations. Two octavo vols., 1468 pp. Cloth,$7.00. 

BRUNTON'S PHARMACOLOGY, THERAPEU- 
TICS AND MATERIA MEDICA. Octavo, 1305 
pages, 230 illustrations. 

HERMANN'S EXPERIMENTAL PHARMACOL- 
OGY. A Handbook of Methods for Determining 
the Physiological Action of Drugs. Translated, 
with the Author's permission, and with exten- 
sive additions, by R. M. Smith, M. D. 12mo., 
199 pages, with 32 illustrations. Cloth, $1.50. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



14 Prac. of iledicine, Treatment, Digestive Syst. 
Lyman's Practice of Medicine. 

The Principles and Practice of Medicine. For the Use of Medical 
Students and Practitioners. By Henry M. Lyman, M. D., Professor of the Principles 
and Practice of Medicine, Rush Medical College, Chicago. In one very handsome octavo 
volume of 925 pages, with 170 illustrations. Cloth, $4.75 ; leather, $5.75. 



Professor Lyman's valued and extensive expe- 
rience here reduced in text-book form, is indeed 
very valuable both to college students and physi- 
cians. In this work we have an excellent treatise 
on the practice of medicine, written by one who 
is not only familiar with his subject, but who has 
also learned through practical experience in teach- 
ing what are the needs of the student and how 
to present the facts to his mind in the most readily 
assimilable form. Each subject is taken up in 
order, treated clearly but briefly, and dismissed 
when all has been said that need be said in order 
to give the reader a clear-cut picture of the dis- 
ease under discussion. The reader is not con- 
fused by having presented to him a variety of 
different methoos of treatment, among which he 
is left to choose the one most easy of execution, 
but the author describes the one which is, in his 
judgment, the best. This is as it should be. The 
student and even the practitioner, should be 
taught the most approved method of treatment. 
The practical and busy physician, who wants to 



ascertain in a short time all the necessary facts 
concerning the pathology or treatment of any dis- 
ease will find here a safe and convenient guide. — 
The Charlotte Medical Journal. 

The reader of the above volume will be at once 
struck with its excellence. Its contents are com- 
plete and concise, it is fully abreast with the times, 
and is such a book as is needed by students and 
practitioners. The average doctor has neither the 
time nor the patience to read through the pages 
of an encyclopedia to gain the points he desires. 
This Practice will give him all the necessary in- 
formation in a form easily grasped. The parts of 
chapters relating to differential diagnosis leave 
nothing to be desired; they show the author's 
familiarity with his subjects, and his methods as 
a teacher. Evidently the points are not culled 
from other volumes; they bear the stamp of 
originality. In a word, the volume is up to date, 
is readable and instructive, and is far superior to 
the majority of books of the kind.— University 
Medical Magazine. 



The Tear-Book of Treatment for 1895. Just Ready. 

A Comprehensive and Critical Review for Practitioners of Medi 
cine and Surgery. In one 12mo.vol. of 495 pages. Cloth, $1.50. 

%.*%. For special commutations with periodicals see pages 1 and 2. 



It would be difficult indeed to imagine a book 
more nearly suited to the everyday needs of the 
medical practitioner or writer than this. The con- 
tributors to this volume are among the most promi- 



practitioner needs. He can find anything pertain- 
ing to any subject in a moment's time, and he may 
rest assured that it is the most modern and reliable 
view now accepted. It, year by year, keeps him 



nent and well-known writers and teachers of the i apprised of important advances in all branches 



day, and their articles and opinions will be appre- 
ciated by all who are fortunate and wise enough 
to secure them. It is the very book the busy 



of medicine, and presents them in a well-con- 
densed and classified form. — The Charlotte Med- 
ical Journal, May, 1895. 



The Year-Books of Treatment for 1891, 1892, and 1893. 

12mos., 485 pages. Cloth, $1.50 each. 



The Year-Books of Treatment for 1886 and 1887. 

Similar to above. 12mos., 320-341 pages. Cloth, $1.25 each. 

Habershon on the Abdomen. 

On the Diseases of the Abdomen ; Comprising those of the Stomach, and 
other parts of the Alimentary Canal, (Esophagus, Caecum, Intestines and Peritoneum. By 
S. O. Habershon, M. D., Senior Physician to and late Lecturer on Principles and Prac- 
tice of Medicine at Guy's Hospital, London. Second American from third enlarged and 
revised English edition. In one handsome octavo vol. of 554 pages, with illus. Cloth, $3.50. 



This valuable treatise on diseases of the stomach 
and abdomen will be found a cyclopaedia of infor- 
mation, systematically arranged, on all diseases of 
the alimentary tract, from the mouth to the 



rectum. A fair proportion of each chapter is 
devoted to symptoms, pathology, and therapeutics. 
— New York Medical Journal. 



TANNER'S MANUAL OF CLINICAL MEDICINE 
AND PHYSICAL DIAGNOSIS. Third American 
from the second London edition. Revised anH 
enlarged by Tilbxjey Fox, M.D. In one 12mo. 
volume of 362 pp. with illus. Cloth, $1.50. 

DAVIS 1 CLINICAL LECTURES ON VARIOUS 
IMPORTANT DISEASES. By N. S. Davis, 
M. D. Edited by Frank H. Davis, M. D. Second 
edition. 12mo. 287 pages. Cloth, $1.7fi. 

WALSHE ON THE DISEASES OF THE HEART 
AND GREAT VESSELS. Third American edi- 
tion. In 1 vol. 8vo., 416 pp. Cloth, $3.00. 

HOLLAND'S MEDICAL NOTES AND REFLEO 
TIONS. 1 vol. 8vo., pp. 493. Cloth, $3.50. 

TODD'S CLINICAL LECTURES ON CERTAIN 
ACUTE DISEASES. In one octavo volume of 
320 pages. Cloth. $2.50. 

FLINT'S PRACTICAL TREATISE ON THE 
PHYSICAL EXPLORATION OF THE CHEST 
AND THE DIAGNOSIS OF DISEASES AF- 
FECTING THE RESPIRATORY ORGANS. 
Second and revised edition. In one handsome 
octavo volume of 591 pages. Cloth, $4.50. 

STURGES' INTRODUCTION TO THE STUDY 



OF CLINICAL MEDICINE. Being a Guide to 
the Investigation of Disease. In one handsome 
12mo. volume of 127 pages. Cloth, $1.25. 

REYNOLDS' SYSTEM OF MEDICINE. With 
notes and additions by Henry Hartshorne, A.M., 
M. D. Three octavo volumes, containing 3056 
double-columned pages, with 317 illustrations. 
Price per volume, cloth, $5.00; sheep, $6.00; half 
Russia, $0.50. Subscription only. 

WATSON'S LECTURES ON THE PRINCIPLES 
AND PRACTICE OF PHYSIC. Edited with 
additions, and 190 illustrations, by Henry Harts- 
horne, A.M., M. D. In two large octavo volumes 
of 1840 pages. Cloth, $9.00; leather, $11.00. 

PEPPER'S SYSTEM OF PRACTICAL MEDI- 
CINE BY AMERICAN AUTHORS Edited by 
William Pepper, M. D., LL. D., Provost and 
Professor of the Theory and Practice of Medi- 
cine and of Clinical Medicine in the Univer- 
sity of Pennsylvania. The complete work, in 
five volumes, contains 5573 pages, with 198 illus- 
trations. Price, per volume, cloth, $5; leather, 
$6; half Russia, $7. Subscription only. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Practice of fledicine, Diagnosis, Heart, 



15 



Musser's Medical Diagnosis. 

A Practical Treatise on Medical Diagnosis For the Use of Students 
and Practitioners. By John H. Musser, M. D., Assistant Professor of Clinical Medicine, 
University of Pennsylvania, Philadelphia. Tn one very handsome octavo volume of 873 
pages, with 162 illustrations and 2 colored plates. Cloth, $5; leather, $6. 



The aim of the author has been to make 
the work eminently practical. Dr. Musser 
has succeeded in bringing together a large arid 
valuable collection of clinical data drawn from his 
own extended experience and from exhaustive 
literary research, and has presented them in an 
unusually clear and concise manner. In brief, 
the book is thoroughly modern, readable and in- 
structive, and, we believe, superior to any work of 
the kind before the profession. — University Medical 
Magazine. 

Modern methods of medical teaching and study 
have rendered treatises like the present an abso- 
lute necessity. The present work is to be com- 
mended alike for its logical arrangement, accurate 
observation and clearness of expression. The 
chapter on bacteriology is especially commenda- 
ble, because it contains everything practically 
necessary for clinical work. — Medical Record. 

The book should receive a hearty reception from 
students and medical men ; it contains much in- 



formation essential to good, scientific medical 
work. It is with pleasure that we can state that 
the work has been adopted as a text-book at the 
Johns Hopkins Medical School and Harvard Uni- 
versity, and that it has met with marked approval 
in other teaching centres. -International Medical 
Magazine. 

The whole book impresses one as being the 
concentration of a very thorough knowledge of 
all the fact? resorted to in the making of a careful 
diagnosis by means of modern methods. Dr. 
Musser's book will at once take a prominent and 
permanent position among the text-books of the 
medical schools of the country, and we recom- 
mend it most highly to those practitioners who 
wish not only to get the views of the general pro- 
fession in regard to important points of diagnosis, 
but who also desire a work in which the author 
expresses his own opinions, based upon careful 
observation and wide experience. — The Thera- 
peutic Gazette. 



Flint on Auscultation and Percussion.— Fifth Edition. 

A. Manual of Auscultation and Percussion ; Of the Physical Diagnosis 
of Diseases of the Lungs and Heart, and of Thoracic Aneurism. By Austin Flint, M. D., 
LL. D., Professor of the Principles and Practice of Medicine in Bellevue Hospital Medi- 
cal College, New York. Fifth edition. Edited by James C. Wilson, M. D., Lecturer 
on Physical Diagnosis in the Jefferson Medical College, Philadelphia. In one hand- 
some royal 12mo. volume of 274 pages, with 12 illustrations. 

Whitla's Dictionary of Treatment. 

A Dictionary of Treatment ; or Therapeutic Index, including 
Medical and Surgical Therapeutics. By William Whitla, M. D., Professor 
of Materia Medica and Therapeutics in the Queen's College, Belfast. Revised and adapted 
to the United States Pharmacopoeia. In one square, octavo vol. of 917 pp. Cloth, $4.00. 

the younger practitioner will find in it exactly the 
help he so often needs in the treatment both of 
those who are ill, and those who are ailing. At the 
same time the most experienced members of the 
profession may usefully consult its pages for the 
purpose of learning what is really trustworthy in 
the later therapeutic developments. The Diction- 
ary is, in short, the recorded experience of a prac- 
tical scientific therapeutist, who has carefully 
studied diseases and disorders at the bed-side and 
in the consulting-room, and has earnestly ad- 
dressed himself to the cure and relief of his 
patients. — The Glasgow MedicalJoumal. 



We have already dictionaries of medicine and 
dictionaries of surgery; Dr. Whitla now provides 
us with a dictionaryof treatment. And reference 
to the volume shows that it really is what it 
professes to be. The several diseased condi- 
tions are arranged in alphabetical order, and 
the methods— medical, surgical, dietetic, and 
climatic— by which they may be met, considered. 
On every page we find clear and detailed direc- 
tions for treatment supported by the author's 
personal authority and experience whilst the 
recommendations of other competent observers 
are also critically examined. The book abounds 
with useful, practical hints and suggestions, and 



Taylor's Index of Medicine.— Just Ready. 

An Index of Medicine. By Seymour Taylor, M. D., M. E. C. P., Assistant 
Physician to the West London Hospital. In one 12mo. vol. of 802 pages. Cloth, $3.75. 

systems of the body are considered, and the 



The author has prepared a work of great value 
alike to physicians and students. The volume is 
a concise "Practice of Medicine," the diseases 
being grouped systematically in order to secure 
for the reader the many advantages resulting 
from rational arrangement. After valuable chap- 
ters on " Disease," "General Pathology," "Gen- 
eral Diseases," "Specific Infectious Diseases" 



of 
cause, symptoms, pathology, treatment and 
prognosis of each affection are succinctly stated. 
Numerous illustrations together with tabulations 
of differential diagnosis, tests, etc., elucidate the 
text and condense a great amount of necessary 
knowledge in the clearest manner. The work is 
one which merits and will doubtless obtain a 



and "Specific Fevers," the various organs and I wide popularity.— The St. Louis Clinique, May, 1895. 

Fothergill's Handbook of Treatment.— Third Edition. 

The Practitioner's Handbook of Treatment ; Or, The Principles of 
Therapeutics. By J. Miener Fothergiee, M. D., Edin., M. K. C. P., Lond., Physician 
to the City of London Hospital for Diseases of the Chest. Third edition. In one 8vo. 
volume of 661 pages. Cloth, $3.75 ; leather, $4.75. 

This is a wonderful book. If there be such a together in a single chapter, and the relations 
thing as " medicine made easy," this is the work to between the two clearly stated, cannot fail to prove 
accomplish this, result.— Virginia Medical Monthly, a great convenience to many thoughtful but busy 

To have a description of the normal physiologi- physicians. The practical value of the volume is 
cal processes of an organ and of the methods of greatly increased by the introduction of many 
treatment of its morbid conditions brought prescriptions.— New York Medical Journal. 



BROADBENT ON THE PULSE. In one 12mo. volume of 312 pages. Cloth, $1.75. See Series of 
Clinical Manuals, page 30. 

Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



16 Practice, Electricity, Cholera, Food, Hygiene. 
Hayem's Physical and Natural Therapeutics.— Shortly. 

Physical and Natural Therapeutics. The Eemedial Use of Heat, 
Electricity, Modifications of Atmospheric Pressure, Climates and Mineral Waters. By 
Georges Hayem, Professor of Clinical Medicine in the Faculty of Medicine of Paris. 
Edited with the assent of the Author by Hobart Amory Hare, M. D., Professor of 
Therapeutics in the Jefferson Medical College of Philadelphia. In one handsome octavo 
volume with numerous illustrations. 

The merited and increasing importance of non-medicinal therapeutics makes this volume 
one of timely interest, and the eminent standing of author and editor will ensure for it a 
position of undisputed authority and value. 

Herrick's Diagnosis.— Shortly. 

A Handbook of Diagnosis. By James B. Herrick, M. D., Adjunct 
Prof, of Medicine, Eush Medical Coll., Chicago. In one 12mo. vol. of about 400 pages. 

Yeo's Medical Treatment. 

A Manual of Medical Treatment or Clinical Therapeutics. By 

1. Burney Yeo, M. D., F. K. C. P., Prof, of Clinical Therapeutics in King's Coll., London. 
In two 12mo. volumes containing 1275 pages, with illustrations. Cloth, $5.50. 

In Dr. Yeo's book the study of the treatment of given with regard to diet, mode of life, and gen- 
disease is approached, not from the side of the eral treatment, wh''ch are often as important as the 
drug or remedy as in works on therapeutics, but j treatment by drugs. — Med. Chronicle, January, 1894. 
"from the side of the disease." The various dis- i The discussion of the different ailments has a 
eases are grouped together, a short account is given | distinctly practical turn toward the main purpose 
of the clinical history, course and pathology of [ of the book. Standard formulas are introduced 

from eminent practitioners, and all the drugs of 
recognized value are grouped in the order of their 
importance. The dosage receives careful atten- 
tion, which is a feature that cannot be too highly 
commended. It cannot fail to be an exceedingly 
useful, suggestive and instructive work to the 
physician who wishes to be well up ia the present 
advanced and scientific therapeutics of the day. — 
Medical Record. 



each, and from a consideration thereof, indications 
for treatment are arrived at; then follows a full dis- 
cussion of the best methods of carrying out these 
indications. Each section contains a number of 
prescriptions which the author has found most 
useful, and at the end of every chapter is added a 
selection of formulae from the writings of various 
well-known physicians. The work is exceedingly 
practical, and the details of the various methods 
of treatment are always given. Full directions are 



Yeo on Food in Health and Disease. 

Food in Health and Disease. By I. Burney Yeo, M.D., F.K.C.P., 

Professor of Clinical Therapeutics in King's College, London. In one 12mo. volume of 
590 pages. Cloth, $2 00. See Series of Clinical Manuals, page 30. 

Dr. Yeo supplies in a compact form nearly all that 
the practitioner requires to know on the subject of 



diet The work is divided into two parts— food 
health and food in disease. Dr. Yeo has gathered 
together from all quarters an immense amount of 
useful information within a comparatively small 



compass, and he has arranged and digested his 
materials with skill for the use of the practitioner. 
We have seldom seen a book which more thor- 
oughly realizes the object for which it was written 
than this little work of Dr. Yeo.— British Medical 
Journal. 



Bartholow on Cholera. 

Cholera : Its Causes, Symptoms, Pathology and Treatment. By 

Roberts Bartholow, M. D., LL. D., Emeritus Professor of Materia Medica, General 
Therapeutics and Hygiene in the Jefferson Medical College of Philadelphia. In one 12mo. 
volume of 127 pages, with 9 illustrations. Cloth, $1.25. 

The author has sought to make a practical book I and the latest therapeutical methods in vogue in 
in the smallest compass. The symptoms and India, Europe and America. The volume is writ- 



pathology of the disease are described separ- 
ately in a brief and comprehensive manner. The 
final chapter, on the treatment of cholera, gives 
the prophylactic measures, including quarantine 



ten in the author's usual pleasant style, and will 
satisfy the desire of any one that wishes to obtain 
the most recent information on the subject. — The 
New York Medical Journal. 



Richardson's Preventive Medicine. 



Preventive Medicine. By B. 

low of the Eoyal Coll. of Phys., London. In 
There is perhaps no similar work written for 
the general public that contains such a complete, 
reliable and instructive collection of data upon 
the diseases common to the race, their origins, 
causes, and the measures for their prevention. 
The descriptions of diseases are clear, chaste and 



W. Eichardson, M. D., LL. D., F. E. S., Fel- 
one 8vo. vol. ot 729 pp. Cloth, $4; leather. $5. 

scholarly ; the discussion of the question of disease 
is comprehensive, masterly and fully abreast with 
the latest and best knowledge on the subject, and 
the preventive measures advised are accurate, 
explicit and reliable.— TheAmerican Journal of the 
Medical Sciences. 



BARTHOLOW'S PRACTICAL TREATISE ON 
THE APPLICATIONS OF ELECTRICITY TO 
MEDICINE AND SURGERY. By Roberts 
Bartholow, A.M., M.D., LL.D., Emeritus Pro- 
fessor of Materia Medica and General Thera- 
peutics in the Jefferson Med. Coll. of Philadel- 
phia, etc. Third edition. In one octavo volume 
of 308 pages, with 110 illustrations. 

PAVY'S TREATISE ON THE FUNCTION OF DI- 
GESTION; its Disorders and their Treatment. 
From the second London edition. In one octavo 
volume of 238 pages. Cloth, $2.00. 



SCHREIBER'S MANUAL OF TREATMENT BY 
MASSAGE AND METHODICAL MUSCLE EX- 
ERCISE. Translated by Walter Mendelson, 
M.D., of New York. In one 8vo. volume of 274 
pp., with 117 engravings. 

CHAMBERS' MANUAL OF DIET AND REGIMEN 
IN HEALTH AND SICKNESS. In one hand- 
some octavo volume of 302 pp. Cloth, 82.75. 

STILLE ON CHOLERA: Its Origin, History, 
Causation, Symptoms, Lesions, Prevention and 
Treatment. In one handsome 12mo. volume of 
163 pages, with a chart. Cloth, $1.25. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Throat, Nose, Lungs, Hind, Nerves. 



17 



Seiler on the Throat and Nose.— Fourth Edition. 

A Handbook of Diagnosis and Treatment of Diseases of the 
Throat, Nose and Waso-Pharynx. By Carl Seiler, M.D., Lecturer on 
Laryngoscopy in the University of Pennsylvania. Fourth edition. In one handsome 
12mo. volume of 414 pages, with 107 illustrations and 2 colored plates. Cloth, $2.25. 



This little book is eminently practical, and will 
prove of interest not only to the specialist, but to 
'he general practitioner as well. It deals with the 
subject in a clear and distinct manner, and the 
text is copiously illustrated with diagrams and 
colored plates. So little attention is paid ordi- 
narily to the examination of the larynx that the 
need of such a book has long been felt. By con- 
suming its pages anyone can learn the necessary 
manipulations, and, by a little practice, soon be- 



come expert in the use of the laryngeal mirror, a 
method of examination too often neglected. The 
anatomy of the larynx is explained with especial 
care, and the operative procedures for various 
diseases of the throat, tonsils, etc., are carefully 
explained. Approved methods of treatment are 
dealt with in a very satisfactory way, and all the 
most useful remedial agents are described.— 
International Medical Magazine. 



Browne on the Throat and Nose.— Fourth Edition. 

The Throat and Nose and Their Diseases. By Lennox Browne, 
F. K. C. S., E., Senior Physician to the Central London Throat and Ear Hospital. 
Fourth and enlarged edition. In one imperial octavo volume of 751 pages, with ] 20 
illustrations in color, and 235 engravings on wood. Cloth, $6.50. 



The subject is here exhaustively treated on 
lines of thorough acquaintance with the anatomy, 
the physiology and physics of the organs involved 
and the pathology of the disease to which they 
are subject. To the author we have awarded the 
credit of having added to a thorough understand- 
ing of the diseases with which he deals the choice 
of the best treatment afforded by the present state 



of knowledge. — The Amer, Practitioner and News. 

Although quite complete enough for the use of 
specialists, it is at the same time so clear as to be 
of daily value to the general practitioner, who will 
find at the end of the volume a number of well- 
tried formulas most in vogue at the London hos- 
pitals for diseases of the throat.— The Canada 
Medical Record. 



Mackenzie on the Nose and Throat.— Preparing. 

The Diseases of the Nose and Throat. By John JSoland Macken- 
zie, M. D.. Lecturer on Laryngology in the Medical School of the Johns Hopkins Uni- 
versity, Clinical Professor of Diseases of the Throat and Nose in the University of 
Maryland, Baltimore. In one octavo volume of about 600 pages, richly illustrated. 

Tuke on the Influence of the Mind on the Body. 

Illustrations of the Influence of the Mind upon the Body in 
Health and Disease. Designed to elucidate the Action of the Imagination. By 
Daniel Hack Tuke, M. D., Joint Author of the Manual of Psychological Medicine, 
etc. New edition. Thoroughly revised and rewritten. In one 8vo. volume of 467 pages, 
with 2 colored plates. Cloth, $3.00. 



It is impossible to peruse these interesting chap- 
ters without being convinced of the author's per- 
fect sincerity, impartiality, and thorough mental 
grasp. Dr. Tuke has exhibited the requisite 
amount of scientific address on all occasions, and 
the more intricate the phenomena the more firmly 
has he adhered to a physiological and rational 



method of interpretation. Guided by an enlight- 
ened deduction, the author has reclaimed for 
science a most interesting domain in psychology, 
previously abandoned to charlatans and empirics. 
This book, well conceived and well written, must 
commend itself to every thoughtful understand- 
ing. — New York Medical Journal. 



(Houston on Mental Diseases. 

!^~ Clinical Lectures on Mental Diseases. By Thomas S. Clouston, 
M. D., Lecturer on Mental Diseases in the University of Edinburgh. With an Appen- 
dix, containing an Abstract of the Statutes of the United States and of the Several 
States and Territories relating to the Custody of the Insane. By Charles F. Folsom, 
M. D., Ass't Professor of Mental Diseases, Med. Dep. of Harvard Univ. In one octavo 
volume of 541 pages, with eight lithographic plates, four of which are colored. Cloth, $4. 
JI^^Dr. Folsom's Abstract also separate, in one 8vo. vol. of 108 pages. Cloth, $1.50. 
The descriptions of the diseases and cases are and descriptions given as to the practical man- 
simple and practical, but true; and one sees as he agement and care of the cases. We can heartily 
reads that they are given by one perfectly familiar recommend it to the student and busy general 
from daily observation with the cases and diseases practitioner. Dr. Folsom's work greatly increases 
he is speaking of. One feature of the book which | the value of Dr. Clouston's book for the American 
commends it highly, and which is not to be found j practitioner. — Archives of Medicine. 
in any other work on mental diseases, is the hints I 

Playfair on Nerve Prostration and Hysteria. 

The Systematic Treatment of Nerve Prostration and Hysteria. 

By W. S. Playeaie, M. D., F. B. C. P. In one 12mo. volume of 97 pages. Cloth, $1.00. 



BROWNE ON KOCH'S REMEDY IN RELATION 
TO THROAT CONSUMPTION. In one octavo 
volume of 121 pages, with 45 illustrations, 4 of 
which are colored, and 11 charts, Cloth, Si. 50. 

FULLER ON DISEASES OF THE LUNGS AND 
AIR-PASSAGES. Their Pathology, Physical Di- 
agnosis, Symptoms and Treatment. From the 
second and revised English edition. In one 
octavo volume of 475 pages. Cloth, $3.50. 

SLADE ON DIPHTHERIA; its Nature and Treat- 
ment, with an account of the History of its Pre- 



valence in various Countries. Second and revised 
edition. In one 12mo. vol., 158 pp. Cloth, $1.25. 

SMITH ON CONSUMPTION; its Early and Reme- 
diable Stages. 1 vol. 8vo., 253 pp. Cloth, $2.25. 

LA ROCHE ON PNEUMONIA. 1 vol. 8vo. of 490 
pages. Cloth, $3.00. 

WILLIAMS ON PULMONARY CONSUMPTION; 
its Nature, Varieties and Treatment. With an 
analysis of one thousand cases to exemplify its 
duration. In one 8vo. vol. of 303 pp. Cloth, $2.50. 



Lea Brothers & Co.. Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



18 Nervous and flental Diseases, Histology. 
Dercum on Nervous Diseases— In Press. 

A Text-Book on Nervous Diseases. By American Authors. Edited 
bv F. X. Dercum, M. D., Clinical Professor of Diseases of the Nervous System in the 
Jefferson Medical College, Philadelphia. In one handsome octavo volume of about 
1000 pages, profusely illustrated. 

LIST OF CONTRIBUTORS. 

N. E. Brill, M.D. S Weib Mitchell, M.D. 

Charles W. Burr, M.D. C. A. Herter, M.D. Charles A. Oliver, M.D. 

Joseph Collins, M.D. George W. Jacoby, M.D. "William Osler, M.D. 

Charles L. Dana, M.D. William W. Keen, M.D. Frederick Peterson, M.D. 

F. X. Derctjm,M.D. Philip Coombs Knapp, M.D. Morton Prince, M.D. 

Geo. E. de Schweinitz, M.D. James Hendrie Lloyd, M.D. Wharton Sinkler. M.D. 

E. D. Fisher, M.D. Charles K. Mills, M.D. M. Allen Starr, M.D. 

Landon Carter Gray, M.D. James C. Wilson, M. D. 

Gray on Nervous and Mental Diseases. 

A Practical Treatise on Nervous and Mental Diseases. By 
Landon Carter Gray, M. D., Professor of Diseases of the Mind and .Nervous System 
in the New York Polyclinic. In one very handsome octavo volume of 681 pages* with 
168 illustrations. Cloth, $4.50; leather, $5.50. 

Mitchell on Nerve Injuries and Their Treatment.— In Press. 

Remote Consequences of Injuries of Nerves and Their Treat- 
ment. An examination of the present condition of wounds received in 1863-5, with 
additional illustrative cases. By John K. Mitchell, M. D., Assistant Physician to the 
Orthopaedic Hospital and Infirmary for Nervous Diseases, Philadelphia. In one hand- 
some 12mo. volume of 239 pages, with 12 illustrations. Cloth, $1.75. Just ready. 

The author has chosen a subject of great clinical importance to physicians as well as to 
surgeons. Injuries of the nerves are common in civil as well as in military life and lead to 
various painful and intractable conditions. Dr. Mitchell has had access to authentic records 
covering thirty years, and his researches arrive at important results based upon an ample 
number of cases under observation for a prolonged period. 

Ross on Diseases of the Nervous System. 

A Handbook on Diseases of the Nervous System. By James 
Boss, M. D., F. R. C.P., LL.D., Senior Assistant Physician to the Manchester Royal 
Infirmary. In one octavo vol. of 725 pages, with 184 illus. Cloth, $4.50 ; leather, $5.50. 
This admirable work is intended for students of which it treats. In every part this handbook 
medicine and for such medical men as have no time 
for lengthy treatises. It is a concise and philo- 
sophical guide to the department of medicine of 



merits the highest praise, and will no doubt be 
found of the greatest value to the student as well 
as to the practitioner. — Edinburgh Medical Journal. 



Hamilton on Nervous Diseases.— Second Edition. 

Nervous Diseases ; Their Description and Treatment. By Allen McLane 
Hamilton, M. D., Attending Physician at the Hospital for Epileptics and Paralytics, 
Blackwell's Island, N. Y. Second edition, thoroughly revised and rewritten. In one 
octavo volume of 598 pages, with 72 illustrations. Cloth, $4.00. 

Savage on Insanity and Allied Neuroses. 

Insanity and Allied Neuroses, Practical and Clinical. By George 
H. Savage, M. D., Lecturer on Mental Diseases at Guy's Hospital, London. In one 
12mo. vol. of 551 pp., with 18 illus. Cloth, $2.00. See Series of Clinical Manuals, p. 30. 

Klein's Histology.— Fourth Edition. 

Elements of Histology. By E. Klein, M. D., F. E. S., Joint Lecturer on 
General Anatomy and Physiology in the Medical School of St. Bartholomew's Hospital, 
London. Fourth edition. In one 12mo. volume of 376 pages, with 194 illus. Limp 
cloth, $1.75. See Students' Series of Manuals, page 30. 

The large number of editions through which concise manner in which it is written, the 
Dr. Klein's little handbook of histology has run absence of debatable matter, of conflicting views, 
since its first appearance in 1883 is ample evidence 
that it is appreciated by the medical student and 
that it supplies a definite want. The clear and 



added to the convenient size of the book and its 
moderate price, will account for its undoubted 

success. — Medical Chronicle. 



Schafer's Histology.— Third Edition. 

The Essentials of Histology. By Edward A. Schafer, F. K. S., Jodrell 
Professor of Physiology in University College, London. New (third) edition. In one 
octavo volume of 311 pages, with 325 illustrations. Cloth, $3.00. 



BLANDFORD ON INSANITY AND ITS TREAT- 
MENT. Lectures on the Treatment, Medical 
and Legal, of Insane Patients. In one very 
handsome octavo volume. 

JONES' CLINICAL OBSERVATIONS ON FUNC- 
TIONAL NERVOUS DISORDERS. Second 



American Edition. In one handsome octavo 
volume of 340 pages. Cloth, $3.25. 
PEPPER'S SURGICAL PATHOLOGY. In one 
pocket-size 12mo. volume of 511 pages, with 81 
illustrations. Limp cloth, red edges, §2.00 See 
Students'" Series of Manuals, page 30. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Pathology, Histology, Bacteriology. 



19 



Abbott's Bacteriology.— New (2d) Edition. Just Ready. 

The Principles of Bacteriology : a Practical Manual for Students and 
Physicians. By A. C. Abbott, M. D., First Assistant, Laboratory of Hygiene, University 
of Pennsylvania, Philadelphia. JS"ew (2d) edition, thoroughly revised and greatly 
enlarged. In one very handsome 12mo. volume of 472 pages, with 94 illustrations, of 
which 17 are colored. Cloth, $2.75. 



Its scope has been much extended, so that it 
now contains all that is necessary for a beginner 
to learn in order to gain a practical working 
knowledge of the subject. Ifc is particularly 
adapted to the wants of students and practitioners 
who wish to pursue their study without the aid of 
an instructor. — Medicine, April, 1895. 

The instructions for methods of work are all 
lucid and concise. It is the most satisfactory and 
comprehensive book on practical bacteriology in 
■our language.— Chicago Clinical Review, Nov., 1894. 

The second edition has been much enlarged by 
the addition of much new matter. Its illustra- 



tion?, partly colored, are helpful in the elucidation 
of the text. Ample instruction is given as to 
needed apparatus, cultures, standings, microscop- 
ic examinations, etc. The pathogenic bacilli are 
fully described both by the text and illustrations, 
and the methods of conducting examinations are 
fully set forth. It will win its way and become a 
favorite.— Virginia Medical Monthly, November, 
1894. 

On the whole the book is one of the best of its 
kind and the most practical in the English lan- 
guage. — Maryland Medical Journal, Nov. 3, 1894. 



Gibbes' Practical Pathology and Morbid Histology. 

Practical Pathology and Morbid Histology. By Heneage Gibbes, 
M. D., Professor of Pathology in the University of Michigan, Medical Department. In 
one very handsome 8vo. vol. of 314 pp., with 60 illus., mostly photographic. Cloth, $2.75. 



In fulness of directions as to the modes of 
investigating morbid tissues the book leaves 
little to be desired. The work is throughout 
profusely illustrated with reproductions of micro- 
photographs. We may say that the practical 
histologist will gain much useful information 
from the book. — The London Lancet. 

The student of morbid histology and bacteri- 
ology has at his hand, in this neat volume of some 
three hundred pages, a most excellent guide and 
one which, unless he be a very advanced student, 
he cannot afford to be without. The work is 
divided into four parts, the first, that of practical 
pathology, containing clear and precise directions 
in histological technique, showing how to prepare 



the tissues for examination, cut, stain and mount 
sections, etc. The second part deals with bacteri- 
ology, with the different forms of cultivation, 
microscopic examinations of the bacteria, etc. 
The third part, which comprises more than half 
the book, treats of morbid histology. This part is 
illustrated with a great number of beautiful photo- 
micrographs in which the microscopic field is 
reproduced with a distinctness that is really 
remarkable. The fourth part contains some very 
practical instruction on photography with the 
microscope. Works like this of Dr. Gibbes will soon 
popularize histology among the profession at large, 
whereas it is now to a large number of physicians 
almost a sealed book. — Medical Record, 



Senn's Surgical Bacteriology.— Second Edition. 

Surgical Bacteriology. By Nicholas Senn, M. D., Ph. D. ; Professor of 
Surgery in Rush Medical College, Chicago. New (second) edition. In one handsome 
octavo of 268 pp., with 13 plates, of which 10 are colored, and 9 engravings. Cloth, $2.00. 



The book is really a systematic collection in the 
most concise form of such results as are published 
in current medical literature by the ablest workers 
in this field of surgical progress ; and to these are 
added the author's own views and the results of 
his clinical experience an d original investigations. 
The book is valuable to the student, but its chief 
value lies in the fact that such a compilation 



makes it possible for the busy practitioner, whose 
time for reading is limited and whose sources of 
information are often few, to become conversant 
with the most modern and advanced ideas in sur- 
gical pathology, which have "laid the foundation 
for the wonderful achievements of modern sur- 
gery." — Annals of Surgery. 



Green's Pathology and Morbid Anatomy.— Seventh Edition. 

Pathology and Morbid Anatomy. By T. Henry Green, M. D., Lecturer 
on Pathology and Morbid Anatomy at Charing-Cross Hospital Medical School, London, 
^ixth American from the seventh and revised English edition. Octavo, 539 pages, with 
167 engravings. Cloth, $2.75. 

The Pathology and Morbid Anatomy of Dr. 
Green is too well known by members of the medi- 
cal profession to need any commendation. There 
is scarcely an intelligent physician anywhere who 
has not the work in his library, for it is almost an 
essential. In fact it is better adapted to the wants 
of general practitioners than any work of the kind 

with which we are acquainted. The works of much in its favor. 
German authors upon pathology, which have been 

Coats' Treatise on Pathology. 

A Treatise on Pathology. By Joseph Coats, M. D., F. F. P. S., Patholo- 
gist to the Glasgow Western Infirmary. In one very handsome octavo volume of 829 
paees, with 339 beautiful illustrations. Cloth, $5.50 ; leather, $6.50. 



translated into English, are too abstruse for the 
physician. Dr. Green's work precisely meets his 
wishes. The cuts exhibit the appearances of 
pathological structures just as they are seen 
through the microscope. The fact that it is so 
generally employed as a text-book by medical stu- 
dents is evidence that we have not spoken too 
Cincinnati Medical News. 



Medical students as well as physicians, who 
desire a work for study or reference, that treats 
the subjects in the various departments in a very 
thorough manner, but without prolixity, will cer- 
tainly give this one the preference to any with 



manner, the changes from a normal condition 
effected in structures by disease, and points out 
the characteristics of various morbid agencies, 
so that they can be easily recognized. But, not 
limited to morbid anatomy, it explains fully how 



which we are acquainted. It sets forth the most the functions of organs are disturbed by abnormal 
recent discoveries, exhibits, in an interesting | conditions.— Cincinnati Medical News. 



PAYNE'S MANUAL OF GENERAL PATHOL- 
OGY. Designed as an Introduction to the Prac- 
tice of Medicine. By Joseph F. Patxe, M. D., 



F. R. C. P., Lecturer on Pathological Anatomy, 
St. Thomas' Hospital, London. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



20 



Surgery. 



Ashhurst's Surgery.— Sixth Edition. 

The Principles and Practice of Surgery. By John Ashhurst, Jr. 
M. D., Professor of Surgery and Clinical Surgery in the Univ. of Penna., Surgeon to the 
Penna. Hospital, Philadelphia. Sixth edition, enlarged and thoroughly revised 
Octavo, 1161 pages, 656 engravings and a colored plate. Cloth, $6.00 ; leather, $7.00 

Ashhurst's Surgery ; maintains in its sixth edition 
the high standard of excellence which has always 
been its characteristic. The author has so thor- 



oughly rt vised his work that the most recent 
appliances and methods in surgery are mentioned. 
Dr. Ashhurst's well-known, comprehensive, and 
yet concise treatment of the various subjects is 
even more marked in this than in the previous 
editions. A great deal of new matter has been 
added.— The Chicago Medical Recorder. 

The author has been before the surgical world 
so long and is so versatile and resourceful that 
his several editions are rapidly taken up. 
Ashhurst has taken great pains to render this 
sixth edition fully equal to the demands of the 
present, and has constructed it on lines which 



erit a continuance of the confidence of the profes- 
sion. In this edition he has incorporated an ac- 
count of the more important recent observations in 
surgical science, as well as such novelties in sur- 
gical practice as meritthe classification of improve- 
ments. Dr. Charles B. Nancrede, of Ann Arbor, 
has contributed a new chapter on surgical bacteri- 
ology; Dr. Barton C. Hirst has revised the sections 
on gynecological subjects; and Drs. George E. 
de Schweinitz and B. Alexander Randall have re- 
vised the chapters on diseases of the eye and ear. 
Those surgeons who possess earlier editions of 
Ashhurst's treatise will make haste to obtain this 
new one. and those who are not familiar with the 
work will necessarily add it to their libraries. 
— Buffalo Medico/ and Surgical Journal. 



Young's Orthopedic Surgery. 

A Manual of Orthopedic Surgery, for Students and Practi- 
tioners. By James K. Young, M. D., Instructor in Orthopaedic Surgery, University of 
Pennsylvania, Philadelphia. In one octavo volume of 446 pages, with 285 illustrations. 
Cloth, $4 ; leather, $5. 

The present work will be found to meet a want j approved modern views, and the treatment is 
among students in acquiring a knowledge of the j very thoroughly and comprehensively considered 
subject, and among practitioners who constantly Especial attention has been given to the mechani< 

cal part of the subject 



see a greater or less number of deformities and 
who desire information regarding the most 
recent views on the pathology and treatment of 
this subject. Dr. Young's large experience has 
particularly fitted him for the preparation of this 
work, which is based upon his personal observa- 
tions, although the literature of the subject has 
been carefully sifted, and whatever of import- 
ance he has thus obtained has been made full 
use of, due credit being given. The pathology 
will be found to correspond with the most 



A very valuable feature 
of the work is the large number of excellently- 
executed drawings which illustrate the text. In 
those cases in which doubt is apt to occur, or in 
which the symptoms may be obscure, the differ- 
ential diagnosis has been very fully given. This 
ground has been well covered, and the work 
may be relied upon as reflecting the present 
position of the subject of which it treats. — Uni- 
versity Medical Magazine, January, 1895. 



Roberts' Modern Surgery. 



The Principles and Practice of Modern Surgery. For the use of Stu- 
dents and Practitioners of Medicine and Surgery. By John B. Koberts, M. D., Prof, of 
Anatomy and Surgery in the Philadelphia Polyclinic. Prof, of Surgery in the Woman's 
Medical College of Pennsylvania. Lecturer in Anatomy in the Univ. of Penna. Octavo, 
780 pages, 501 illustrations. Cloth, $4.50 ; leather, $5.50. 

This work is a very comprehensive manual upon the leading practitioners of the art, and its liter- 
general surgery. It has a thoroughly practical ature is fully up to all the advanced doctrines and 
character, the subjects are treated with rare judg- methods of practice of the present day. — Medical 
ment. its conclusions are in accord with those of Record. 



Druitt's Modern Surgery.— Twelfth Edition. 

Manual of Modern Surgery. By Eobert Druitt, M. K. C. S. Twelfth 
edition, thoroughly revised by Stanley Boyd, M. B., B. S., F. K. C. S. In one 8vo. 
volume of 965 pages, with 373 illustrations. Cloth, $4.00; leather, $5.00. 

Holmes' Treatise on Surgery.— Fifth Edition. 

A Treatise on Surgery ; Its Principles and Practice. By Timothy 
Holmes, M. A., Surgeon and Lecturer on Surgery at St. George's Hospital, London. 
From the fifth English edition, edited by T. Pickering Pick, F. E. C. S. In one 
octavo volume of 997 pages, with 428 illustrations. Cloth, $6.00 ; leather, $7.00. 



MARSH ON THE JOINTS. In one 12mo. volume 
of 468 pages, with 64 woodcuts and a colored 
plate. Cloth, §2.00. See Striesof Clinical Manuals, 
page 30. 

BUTLIN ON DISEASES OF THE TONGUE. By 
Henry T. Bxitlin, F. R. C. S., Assistant Surgeon 
to St. Bartholomew's Hospital, London. In one 
12mo. volume of 456 pages, with 8 colored plates 
and 3 woodcuts. Cloth, $3.50. See Series of Clin- 
ical Manuals, page 30. 

GOULD'S ELEMENTS OF SURGICAL DIAG- 
NOSIS. By A. Pearce Gould, M. S., M. B., 
F.R. C. S., Assistant Surgeon to Middlesex Hos- 
pital, London. In one pocket-size 12mo. volume 
of 589 pages. Cloth, $2.00. See Students' Series 
of Manuals, page 30. 

MILLER'S PRACTICE OF SURGERY. Fourth 
and revised American edition. In one large 8vo. 



vol. of 682 pp.. with 364 illustrations. Cloth , 83.75. 

MILLER'S PRINCIPLES OF SURGERY. Fourth 
American from the third Edinburgh ed. In one 
8vo. vol. of 638 pages, with 340 illus. Cloth, $3.75. 

PIRRIE'S PRINCIPLES AND PRACTICE OF 
SURGERY. Edited by John Neill, M. D. In 
one 8vo. vol. of 784 pp. with 316 illus. Cloth, $3.75. 

GANT'S STUDENT'S SURGERY. By Frederick 
James Gant, F. R. C. S. Square octavo, 84S pages, 
159 engravings. Cloth, $3.75. 

HOLMES' SYSTEM OF SURGERY. THEORET- 
ICAL AND PRACTICAL. By Various Authors. 
Edited by Timothy Holmes, M. A. American edi- 
tion, revised and re-edited by John H. Packard, 
M. D. Three large octavo volumes, 3137 pages, 
979 illustrations on wood and 13 lithographic 
plates. Per set, cloth, $18.00; leather, $21.00 
Subscription only. 



Lea Brothers & Co., Publishers. 7Q6, 708 & 710 Sansom Street, Philadelphia. 



Surgery — (Continued). 21 

Wharton's Minor Surgery and Bandaging.— Secondd Edition. 

Minor Surgery and Bandaging. By Henry E. Wharton, M. D., 
Demonstrator of Surgery in the University of Pennsylvania. In one 12mo. volume of 
529 pages, with 416 engravings, many being photographic. Cloth, $3.00. 

The book is one of the very best treatises on I localities of the body. The author has thoroughly 
minor surgery and it ought to be adopted as a ! revised that portion of the work relating to the 
text-book on the subjects of which it treats. It aseptic and antiseptic methods of wound treat- 
contains more practical surgery within its limits | ment, than which there is no more important 
and boundaries than any book of its kind we have i subject in the whole domain of surgery. Much 
ever seen. Its illustrations are to be specially new matter has been added, which brings it 
commended, particularly those that relate to abreast of the very latest knowledge on the sub- 
bandaging, most of which have been taken from jects of which it treats.— Buffalo Medical and Sur- 
photographs of applied bandages in the several | gical Journal. 



Treves' Operative Surgery.— Two Volumes. 

A Manual of Operative Surgery. By Frederick Treves, F. E. C. S., 
Surgeon and Lecturer on Anatomy at the London Hospital. In two octavo volumes 
containing 1550 pages, with 422 engravings. Complete work, cloth, $9.00; leather, $11.00. 



Mr. Treves in this admirable manual of opera- 
tive surgery- has in each instance practically 
assumed that operation has been decided upon 
and Has then proceeded to give the various opera- 
tive methods which may be employed, with a 
criticism of their comparative value and a detailed 
and careful description of each particular stage 
of their performance. Especial attention has been 
paid to the preparatory treatment of the patient 
and to the details of the after treatment of the 
case, and this is one of the most distinctive among 
the many excellent features of the book. We have 
no hesitation in declaring it the best work on the 
subject in the English language, and indeed, in 
many respects, the best in any language. It can- 



not fail to be of the greatest use both to practical 
surgeons and to those general practitioners who, 
owing to their isolation or to other ciroumstances, 
are forced to do much of their own operative work. 
We feel called upon to recommend the book so 
strongly for the excellent judgment displayed in 
the arduous task of selecting from among the 
thousands of varying procedures those most 
worthy of description ; for the way in which the 
still more difficult task of choosing among the 
best of those has been accomplished; and for the 
simple, clear, straightforward manner in which 
the information thus gathered from all surgical 
literature has been conveyed to the reader.— 
Annals of Surgery. 



Treves' Student's Handbook of Surgical Operations. In one 

square 12mo. volume of 508 pages, with 94 illustrations. Cloth, $2.50. 

A Manual of Surgery. In Treatises by Various Authors, edited by Fred- 
erick Treves, F. R. C. S. In three 12mo. volumes, containing 1866 pages, with 213 
engravings. Price per set, cloth, $6.00. See Students' Series of Manuals, page 30. 

Treves on Intestinal Obstruction. In one 12mo. volume of 522 pages, 
with 60 ill us. Limp cloth, blue edges, $2.00. See Series of Clinical Manuals, page 30. 

Smith's Operative Surgery.— Revised Edition. 

The Principles and Practice of Operative Surgery. By Stephen 
Smith, M. D., Professor of Clinical Surgery in the University of the City of New York. 
Second and thoroughly revised edition. In one very handsome octavo volume of 892 
pages, with 1005 illustrations. Cloth, $4.00 ; leather, $5.00. 

This excellent and very valuable book is one of j surgeon, and even as a book of reference for the 
the most satisfactory works on modern operative | physician not especially engaged in the practice 
surgery yet published. The book is a compendium S of surgery, this volume will long hold a most 
for the modern surgeon. The present edition is | conspicuous place, and seldom will its readers, no 
much enlarged, and the text has been thoroughly j matter how unusual the subject, consult its pages 
revised, so as to give the most improved methods j in vain. Its compact form, excellent print, num- 
in aseptic surgery, and the latest instruments j erous illustrations, and especially its decidedly 
known for operative work. It can be truly said that practical character, all combine to commend it.— 
as a handbook for the student, a companion for the ! Boston Medical and Surgical Journal. 

Erichsen's Science and Art of Surgery.— Eighth Edition. 

The Science and Art of Surgery ; Being a Treatise on Surgical Injuries, 
Diseases and Operations. By John E. Erichsen, F. E. S., F. K. C. S., Professor of Sur- 
gery in University College, London, etc. From the eighth and enlarged English edition. 
In two large 8vo. vols, of 2316 pp., with 984 engravings on wood. Cloth, $9; leather, $11. 

Bryant's Practice of Surgery.— Fourth Edition. 

The Practice of Surgery. By Thomas Bryant, F. R. C. S., Surgeon and 
Lecturer on Surgery at Guy's Hospital, London. Fourth American from the fourth and 
revised English edition. In one large and very handsome imperial octavo volume of 1040 
pages, with 727 illustrations. Cloth, $6.50; leather, $7.50. 

Ball on the Rectum and Anus.— New Edition. 

The Rectum and Anus, Their Diseases and Treatment. By 
Charees B. Ball, F. B. C. S., University Examiner in Surgery, Dublin. In one 12mo. 
volume of 453 pages, with 60 engravings and 4 colored plates. Cloth, $2.25. Just ready. 
See Series of Clinical Manuals, p. 30. 

Lea Brothers & Co., Publishers. 706, 708 & 710 Sansom Street, Philadelphia. 



22 Surgery — (Continued), Fractures, Dislocations, 



Vol. I. Just Ready. Vol. II, Shortly. Vols. III. and IV. Preparing. 

A SYSTEM OF SURGERY. 

BY AMERICAN AUTHORS. 

Edited by Frederic S. Dennis, M.D., Professor of the Principles and Practice 
of Surgery, Bellevue Hospital Medical College, New York ; President of the American 
Surgical Association, etc. Assisted by John S. Bielings, M.D., LL.D, D.C.L., Deputy 
Surgeon-General, U. S. A. In four imperial octavo volumes of about 900 pages each, 
prolusely illustrated in black and colors. Price per volume, cloth, $6 ; leather, $7 ; half 
Morocco, gilt back and top, $8.50. For sale by subscription only. Address the Publishers. 



Robert Abbe, M.D., 
Gobham Bacon, M.D. 
Herman M. Biggs, M.D., 
John S. Billings, M.D., 
William T. Bull, M.D., 
William H. Carmalt, M.D., 
Henry C. Coe, M.D., 
P. S. Conner, M.D., 
William T. Councilman, M.D., 
D. Bryson Delavan, M.D., 
Frederic S Dennis, M.D., 
Edward K. Dunham, M.D , 
William H. Fobwood, M.D., 
Geobge R. Fowler, M.D., 
Frederick H. Geebish, M.D., 
Aepad G. Geestee, M.D., 



LIST OF CONTRIBUTORS, 

VlBGIL P. Gibney, M.D., 
William A. Haedaway. M.D., 
Feank T. Haetley, M.D , 
Joseph Tabee Johnson, M.D., 
William W. Keen, M.D., 
William T. Lusk, M.D., 
Chaeles McBueney, M.D., 
Rudolph Matas, M.D., 
Heney H. Mudd, M.D., 
Chaeles B. Nancrede, M.D., 
Henry D. Noyes, M. I)., 
Roswell Park, M.D , 
Willard Parker, M.D., 
Lewis 8. Pilcher, M.D., 
William H. Polk, M.D., 



Charles H. Porter, M.D., 
Maurice H. Richardson, M.D., 
John B. Roberts, M.D., 
Geobge E. de Schweinitz, M.D!, 
Nicholas Senn, M.D., 
Stephen Smith, M.D., 
Lewis A. Stimson, M.D., 
Robeet W. Tayloe, M.D., 
Louis McL. Tiffany, M.D., 
J. Collins Waeeen, M.D., 
Heney R. Whabton, M.D., 
Robert F. Weir, M.D., 
William H. Welch, M.D., 
J. William White, M.D., 
Hobatio C Wood, M.D., 



Hamilton on Fractures and Dislocations.— Eighth Edition. 

A Practical Treatise on Fractures and Dislocations. By Frank 
H. Hamilton, M. D., LL. D., Surgeon to Bellevue Hospital, New York. New (8th) edi- 
tion, revised and edited by Stephen Smith, M. D., Prof, of Clinical Surgery in Univ. of 
City of N. Y. In one octavo volume of 832 pp., with 507 illus. Cloth, $5.50 ; leather, $6.50. 
Its numerous editions are convincing proof if any ject of such magnitude is no easy one. Dr. Smith 
is needed, of its value aud popularity. It is pre- 
eminently the authority on fractures and disloca- 
tions, and universally quoted as such. In the new 
edition it has lost none of its former worth. The 
additions it has received by its recent revision make 
it a work thoroughly in accordance with modern 
practice, theoretically, mechanically, aseptically. 
The task of writing a complete treatise on a sub- 



has aimed to make the present volume a correct 
exponent of our knowledge of this department 
of surgery. The more one reads the more 
one is impressed with its completeness. The work 
has been accomplished, and has been done clearly, 
concisely, excellently well.— Boston Medical and 
Surgical Journal. 



Stimson on Fractures and Dislocations. 

A Treatise on Fractures and Dislocations. By Lewis A. Stimson, 
M.D. In two handsome octavo volumes. Vol. I., Fractures, 582 pages, 360 illustra- 
tions. Vol. II., Dislocations, 540 pages, with 163 illustrations. Complete work, 
cloth, $5.50 ; leather, $7.50. Either volume separately, cloth, $3.00 ; leather, $4.00. 
The appearance of the second volume marks the | exhibits the surgery of Dislocations as it is taught 



completion of the author's original plan of prepar- 
ing a work which should present in the fullest 
manner all that is known on the cognate subjects 
of Fractures and Dislocations. The volume on 
Fractures assumed at once the position of authority 
on the subject, and its companion on Dislocations 
will no doubt be similarly received. This volume 



and practised by the most eminent surgeons of the 
present time. Containing the results of such ex- 
tended researches it must for a long time be re- 



garded as an authority on all subjects pertaining 

•y 
feel it incumbent on him to have it for constant 



ng 
to dislocations. Every practitioner of surgery will 

im to have it 
reference. — Cincinnati Medical News. 



Stimson's Operative Surgery.— Second Edition. 

A Manual of Operative Surgery. By Lewis A. Stimson, B. A., M. D., 
Professor of Clinical Surgery in the University of the City of New York. Second edi- 
tion. In one royal 12mo. volume of 503 pages, with 342 illustrations. Cloth, $2.50. 

Cheyne on Wounds, Ulcers and Abscesses.— Just Ready. 

The Treatment of Wounds, Ulcers and Abscesses. By W.Watson 
Cheyne, M. B., F. B. S., F. R. C. S., Professor of Surgery in King's College, London. In 
one 12mo. volume of 207 pages. Cloth, $1.25. 

Pick on Fractures and Dislocations. 

Fractures and Dislocations. By T. Pickering Pick, F. R. C. S., Sur- 
geon to and Lecturer on Surgery at St. George's Hospital, London. In one 12mo. vol. 
of 530 pp., with 93 illus. Limp cloth, $2.00. See Series of Ginical Manuals, page 30. 

Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Ophthalmology. 



23 



Norris & Oliver's Ophthalmology. 

A Text-Book of Ophthalmology. By William F. Norris, M. D., 
Professor of Ophthalmology in the University of Pennsylvania, and Charles A. Oliver, 
M. D., Surgeon to Wills' Eye Hospital, Philadelphia. In one very handsome octavo 
vol. of 632 pages, with 357 engravings and 5 colored plates. Cloth, $5 ; leather, 



This is the first text-book of diseases of the eye 
written by American authors for American col- 
leges and students. Rules and procedures are 
made so plain arid so evident that any student 
can easily understand and employ them. It is 
succinct in recital, practical in its teachings, judi- 
cious in the selection of material and conservative, 
yet radical when necessary. In treatment it can 
be accepted as from the voice and the pen of a 
respected and recognized authority. The illus- 
trations far outnumber those of its contempora- 
ries, whilst the high grade and unbiased opinions 
of the teachings serve to give it a rank superior 



to any would-be competitor. Wonderfully cheap 
in price, beautifully printed and exquisitely illus- 
trated, the mechanical make-up of the book is 
all that can be desired. After most conscientious 
and painstaking perusal of the work, we unre- 
servedly endorse it as the best, the safest and the 
most comprehensive volume upon the subject that 
has ever been offered to the American medical 
public. We sincerely hope that it may find its 
way into the list of text-books of every English- 
speaking college of medicine. — Annals of Ophthal- 
mology and Otology. 



Berry on the Eye.— New (2d) Edition. 

Diseases of the Eye. A Practical Treatise for Students of Ophthalmology. 
By George A. Berry, M. B., F. B. C. S., Ed., Ophthalmic Surgeon, Edinburgh Boyal 
Infirmary. New (second) edition. In one octavo volume of 750 pages, with 197 illustra- 
tions, mostly lithographic. Cloth, $8.00. 

This is by far the best work upon its theme in "object-lesson." We cannot but reiterate what we 
the English language that we have seen, for the said at the beginning, that we have had great pleas- 
diction is pure and clear, and besides, the beauti- ure in the perusal of this work, and great profit, and 
ful illustrations of normal and diseased conditions that we consider it the best on the subject in the 
make it a valuable addition to the library of all English language to-day, not only for its diction 
practitioners, general as well as special. We have but for its instructive illustrations. — The American 
never seen more real delineation of disease, the Journal of the Medical Sciences. 
coloring is perfect, and each illustration is an 



Juler's Ophthalmic Science and Practice.— New (2d) Edition. 

A Handbook of Ophthalmic Science and Practice. By Henry E. 
Jtjler, F. R. C. S., Senior Assistant Surgeon, Boyal Westminster Ophthalmic Hospital; 
Late Clinical Assistant, Moorfields, London. New (2d) edition. Handsome 8 vo. volume 
of 561 pages, with 201 woodcuts, 17 colored plates, selections from Test-types of Jaeger 
and Snellen, and Holmgren's Color-blindness Test. Cloth, $5.50 ; leather, $6.50. 

The continuous approval manifested towards j matter of practical value. The sections devoted to 
this work testifies to the success with which the treatment are singularly full, and at the same time 
author has produced concise descriptions and concise, and couched in language that cannot fail 
typical illustrations of all the important affections to be understood. — The Medical Age. 
of the eye. The volume is particularly rich in 1 

Nettleship on the Eye.— Fifth Edition. 

Diseases of the Eye. By Edward Nettleship, F. B. C. S., Ophthalmic 
Surgeon at St. Thomas' Hospital, London. Surgeon to the Boyal London (Moorfields) 
Ophthalmic Hospital. Fourth American from the fifth English edition, thor- 
oughly revised. With a Supplement on the Detection of Color Blindness, by Wil- 
liam Thomson, M. D., Professor of Ophthalmology in the Jefferson Medical College 
Philadelphia. In one 12mo. volume of 500 pages, with 164 illustrations, selections from 
Snellen's test-types and formulae, and a colored plate. Cloth, $2.00. 

This is a well-known and a valuable work. It I knowledge to be present which seems to be as- 
was primarily intended for the use of students, sumed in some of our larger works, is not tedious 

from over-conciseness, and yet covers the more 
important parts of clinical ophthalmology.— New 
York Medical Journal. 



and supplies their needs admirably, but it is as 
useful for the practitioner, or indeed more so. It 
does not presuppose the large amount of recondite 



Carter & Frost's Ophthalmic Surgery. 

Ophthalmic Surgery. By B. Brudenell Carter, F. B. C. S., Lecturer on 
Ophthalmic Surgery at St. George's Hospital, London, and W. Adams Frost, F. B. C. S., 
Joint Lecturer on Ophthalmic Surgery at St. George's Hospital, London. In one 12mo. 
volume of 559 pages, with 91 woodcuts, color-blindness test, test-types and dots and appen- 
dix of formulae. Cloth, $2.25. See Series of Clinical Manuals, page 30. 



THOMPSON ON THE URINARY ORGANS. 

Lectures on Diseases of the Urinary Organs. 

By Sir Henry Thompson, Professor of Clinical 

Surgery in University College Hospital, London. 

Second American from the third English edition. 

Octavo, 203 pages, 25 illustrations Cloth, $2 25. 
THOMPSON ON THE PATHOLOGY AND 

TREATMENT OF STRICTURE OF THE 

URETHRA AND URINARY FISTULA. 

From the third English edition. In one octavo 

volume of 359 pages, with 47 engravings and 3 

plates. Cloth, §3.50. 
BASHAM ON RENAL DISEASES: A Clinical 

Guide to their Diagnosis and Treatment. 12mo. 

304 pages, with 21 illustrations. Cloth, $2.00. 



WELLS ON THE EYE. In one octavo volume. 

LAURENCE AND MOON'S HANDY BOOK OF 
OPHTHALMIC SURGERY, for the use of Prac- 
titioners. Second edition. In one octavo vol- 
ume of 227 pages, with 65 illus. Cloth, $2.75. 

LAWSON ON INJURIES TO THE EYE, ORBIT 
AND EYELIDS : Their Immediate and Remote 
Effects. In one octavo volume of 404 pages, with 
92 illustrations. Cloth, 83.50. 

MORRIS ON SURGICAL DISEASES OF THE 

KIDNEY. By Henry Morris, F.R.C.S., Surgeon 

to Middlesex Hospital, London. 12mo., 554 pp., 

' with 40 woodcuts, and 6 colored plates. Limp 

j cloth, $2.25. See Series of Clinical Manuals, p. 30. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



24 Otology, Urinary & Renal Dis., Dentistry. 
Politzer on Diseases of the Ear.— Third Edition. 

A Text-Book of Diseases of the Ear and Adjacent Organs. 

By Dr. Adam Politzer, Imperial-Royal Professor of Aural Therapeutics in the Univer- 
sity of Vienna, Chief of the Imperial -Royal University Clinic for Diseases of the Ear in 
the General Hospital, Vienna. Translated into English from the third ard revised 
German edition, by Oscar Dodd, M. D., Clinical Instructor in Diseases of the Eye and 
Ear, College of Physicians and Surgeons, Chicago. Edited by Sir William Dalby, 
F. B. C. S., M. B., Consulting Aural Surgeon to St. George's Hospital, London. In one 
large octavo volume of 748 pages, with 330 illustrations. Cloth, $5.50. 
This edition of the eminent Vienna professor's i underlie the clinical remarks and details of meth- 



well-known work will be welcomed by those who 
wish to obtain a complete account of all that is 
known in connection with aural diseases. "Who- 
ever peruses it carefully cannot fail to be struck 
with the details, the extensive references, and 
especially the valuable pathological data, which 



ods of treatment. The indications for treatment 
are clear and reliable. We can confidently rec- 
ommend it, for it contains, as stated by the editor 
in his preface, all that is known upon the subject. 
— London Lancet. 



Field's Manual of Diseases of the Ear. 

A Manual of Diseases of the Ear. By George P. Field, M. K. C. S., 
Aural Surgeon and Lecturer on Aural Surgery in St Mary's Hospital Medical School, 
London. In one octavo o f 391 pp., with 73 engravings and 21 colored plates. Cloth, $3.75. 
To those who desire a concise work on diseases i large c ass of cases of ear disease that comes 
of the ear, clear and practical, this manual com- properly within his province. The illustrations 
mends itself in the highest degree. It is just such ; are apt and well executed while the make-up of 
a work as is needed by every general practi- ; the work is beyond criticism.— The American 
tioner to enable him to treat intelligently the | Practitioner and Neios. 

Burnett on the Ear.— Second Edition. 

The Ear, Its Anatomy, Physiology and Diseases. A Practical 
Treatise for the use of Medical Students and Practitioners. By Charles H. Burnett, 
A.M., M. D., Professor of Otology in the Philadelphia Polyclinic; President of the 
American Otological Society. Second edition. In one handsome octavo volume of 580 
pages, with 107 illustrations. Cloth, $4.00 ; leather, $5.00. 

Black on the Urine.— Just Ready. 

The Urine in Health and Disease, and Urinary Analysis, Physi- 
ologically and Pathologically Considered. By D. Campbell Black, M. D., 
L. R. C. S., Professor of Physiology, Anderson College Medical School. In one 12mo. 
volume of 256 pages, with 73 engravings. Cloth, $2.75. 

Roberts on Urinary and Renal Diseases.— Fourth Edition. 

A Practical Treatise on Urinary and Renal Diseases, including 
Urinary Deposits. By Sir William Roberts, M.D., Lecturer on Medicine in the 
Manchester School of Medicine, etc. Fourth American from the fourth London edi- 
tion. In one handsome octavo volume of 609 pages, with 81 illustrations. Cloth, $3.50. 

Purdy on Bright's Disease and Allied Affections. 

Bright's Disease and Allied Affections of the Kidneys. By 

Charles W. Purdy, M. D., Professor of Genito-Urinary and Renal Diseases in the Chi- 
cago Polyclinic. In one octavo vol. of 288 pages, with illustrations. Cloth, $2.00. 

The American Text-Books of Dentistry.— Preparing. 

In Contributions by Various Authors. In two octavo volumes of about 
600 pages each, fully illustrated. Volume I., Operative Dentistry. Edited by 
Edward C. Kirk, D. D. S., Lecturer on Operative Dentistry, Dept. of Dentistry, Univ. of 
Penna. Volume II., Mechanical Dentistry. Edited by Charles J. Essig, M. D., 
D.D. S , Prof, of Mechanical Dentistry and Metallurgy, Dept. of Dentistry, Univ. of Penna. 

The American System of Dentistry. 

In Treatises by Various Authors. Edited by Wilbur F. Litch, M. D., 
D. D. S., Professor of Prosthetic Dentistry, Materia Medica and Therapeutics in the 
Pennsylvania College of Dental Surgery. In three very handsome octavo volumes con- 
taining 3160 pages, with 1863 illustrations and 9 full-page plates. Per volume, cloth, $6 ; 
leather, $7 ; half Morocco, gilt top, $8. For sale by subscription only. 



As an encyclopaedia of Dentistry it has no su 
perior. It should form a part of every dentist's 
library, as the information it contains is of the 

freatest value to all engaged in the practice of 
entistry. — American Journal of Dental Science. 
A grand system, big enough and good enough 
and handsome enough for a monument (which 



doubtless it is), to mark an epoch in the history of 
dentistry. Dentists will be satisfied with it and 
proud of it — they must. It is sure to be precisely 
what the student needs to put him and keep him 
in the right track, while the profession at large 
will receive incalculable benefit from it.— Odonto- 
graphy Journal. 



COLEMAN'S MANUAL OF DENTAL SURGERY 
AND PATHOLOGY By Alfeed Coleman, L.D.S. 
Thoroughly revised and adapted to the use of 



American Students, by Thomas C. Stellwagen, 
D. D.S. Octavo, 412 pages, with 331 illustrations. 
Cloth, $3.25. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Impotence, Sterility, Venereal, Skin. 25 

Gross on Impotence, Sterility, etc.— Fourth Edition. 

A Practical Treatise on Impotence, Sterility, and Allied Dis- 
orders of the Male Sexual Organs. By Samuel W. Gross, A. M., M. D., 
LL. D., Professor of the Principles of Surgery and of Clinical Surgery in the Jefferson 
Medical College of Philadelphia. Fourth edition, thoroughly revised by F. E. Sturgis, 
M. D., Prof, of Diseases of the Genito- Urinary Organs and of Venereal Diseases, 
N. Y. Post Grad. Med. School. In one 8vo. vol. of 165 pages, with 18 illus. Cloth, $1.50. 
Three editions of Professor Gross' valuable book I rhoea, and prostatorrhcea. The book is a practical 
have been exhausted, and still the demand is one and in addition to the scientific and very in- 
unsupplied. Dr. Sturgis has revised and added teresting discussions on etiology, symptoms, etc., 
to the previous editions, and the new one appears | there are lines of treatment laid down that any 
more complete and more valuable than before. J practitioner can follow and wh'ch have met with 
Four important and generally misunderstood sub- I success in the hands of author and editor. — Medi- 
jects are treated — impotence, sterility, spermator- | cal Record. 



Fuller on Male Sexual Disorders.— Shortly. 

Disorders of the Sexual Organs in the Male. By Eugene Fuller, 
M. D , Instructor in Venereal and Genito-Urinary Diseases, New York Post-Graduate 
Medical School. In one very handsome octavo volume of about 200 pages, fully illustrated. 

Taylor on Venereal Diseases.— Sixth Edition. In Press. 

The Pathology and Treatment of Venereal Diseases. Including the 
results of recent investigations upon the subject. By Bobert W. Taylor, A. M., M. D., 
Clinical Professor of Genito-Urinary Diseases in the College of Physicians and Surgeons, 
New York. Being the sixth edition of Bumstead and Taylor, rewritten by Dr. Taylor. 
Large 8vo. volume, about 900 pages, with about 150 engravings, as well as numerous 
chromo-lithographs. In active preparation. 

Culver & Hayden's Manual of Venereal Diseases. 

A Manual of Venereal Diseases. By Everett M. Culver, M. D., 
Pathologist and Assistant Attending Surgeon, Manhattan Hospital, New York, and James 
K. Hayden, M. D., Chief of Clinic Venereal Department, College of Physicians and Sur- 
geons, New Y»rk. In one 12mo. volume of 289 pages, with 33 illus. Cloth, $1.75. 



This book is a practical treatise, presenting in a 
condensed form the essential features of our pres- 
ent knowledge of the three venereal diseases, 
syphilis, chancroid and gonorrhea. We have ex- 
amined this work carefully and have come to the 
conclusion that it is the most concise, direct and 
able treatise that has appeared on the subject of 



venereal diseases for the general practitioner to 
adopt as a guide. The general practitioner needs 
a few simple, concise and clearly presented laws, 
in the execution of which he cannot fail either to 
cure or prevent the ravages of the maladies in 
question and their direful results.— Buffalo Medical 
and Surgical Journal. 



Cornil on Syphilis. 



Syphilis, its Morbid Anatomy, Diagnosis and Treatment. By V. 

Corntl, Professor to the Faculty of Medicine of Paris, and Physician to the Lourcine Hos- 
pital. Specially revised by the Author, and translated with notes and additions by J. 
Henry C. Simes, M. D., Demonstrator of Pathological Histology in the Univ. of Pa., 
and J. Wieliam White, M. D., Lecturer on Venereal Diseases, Univ. of Pa. In one 
handsome octavo volume of 461 pages, with 84 very beautiful illustrations. Cloth, $3.75. 



Hutchinson on Syphilis. 

Syphilis. By Jonathan Hutchinson, F. B. S., F. B. C. S., Consulting Sur- 
geon to the London Hospital. In one 12mo. volume of 542 pages, with 8 chromo- 
lithographs. Cloth, $2.25. See Series of Clinical Manuals, page 30. 

Hardaway's Manual of Skin Diseases. 

Manual of Skin Diseases. With Special Beferenceto Diagnosis and Treat- 
ment. For the use of Students and General Practitioners. By W. A. Hardaway, M. D., 
Professor of Skin Diseases in the Missouri Medical College. 12mo., 440 pp. Cloth, $3.00. 
Dr. Hardaway's large experience as a teacher \ embraces all essential points connected with the 
and writer has admirably fitted him for the diffi- i diagnosis and treatment of diseases of the skin, 
cult task of preparing a book which, while suffi- and we have no hesitation in commending it as 
ciently elementary for the student is yet suffi- j the best manual that has yet appeared in this 
ciently thorough and comprehensive to serve as a ! department of medicine.— Journal of Cutaneous 
book of reference for the general practitioner. It j and Genito- Urinary Diseases. 

GROSS' PRACTICAL TREATISE ON THE DIS- I HILLIER'S HANDBOOK OF SKIN DISEASES; 
EASES, INJURIES AND MALFORMATIONS for Students and Practitioners. Second Ameri- 
OF THE URINARY BLADDER, THE PROS- can edition. In one 12mo. volume of 353 pages, 
TATE GLAND AND THE URETHRA. By I with plates. Cloth, $2.25. 

Samuel D. Geoss, M.D., LL.D., D.C.L., etc. Third ' HILL ON SYPHILIS AND LOCAL CONTAGIOUS 
edition, thoroughly revised by Samuel W. Geoss, | DISORDERS. In one 8vo vol. of 479 p. Cloth, $3.25. 
M.D. In one octavo volume of 574 pages, with LEE'S LECTURES ON SYPHILIS AND SOME 
170 illustrations. Cloth, $4.50. FORMS OF LOCAL DISEASE AFFECTING 

FOX'S EPITOME OF SKIN DISEASES. WITH THE ORGANS OF GENERATION. In one 
FORMULAE. Third edition, revised and en- 8vo. volume of 246 pages. Cloth, $2.25. 
larged. In one 12mo. vol. of 238 pp. Cloth, $1.25. | 



Lea Brothers & Co., Publishers, 706, 708 &710 Sansom Street, Philadelphia. 



26 



Venereal and Skin Diseases. 



Hyde on the Skin.— Third Edition. 

A Practical Treatise on Diseases of the Skin. For the use of Students 
and Practitioners. By J. Kevins Hyde, A. M., M. D., Professor of Dermatology and Ven- 
ereal Diseases in Rush Medical College, Chicago. Third edition. In one octavo volume 
of 802 pages, with 9 colored plates and 108 engravings. Cloth, $5.00 ; leather, $6.00. 
The third edition, just issued, fulfils all the ex- for information as to how to manage his patients 



pectations warranted by the great accumulation 
of dermatological material since the earlier 
editions were brought out, and puts this work at 
the head of the modern American treatises on 
skin diseases. The author has introduced thirty- 
five new diseases in this edition. He is especially 
to be congratulated on his chapter on tuberculosis. 
Five plates and twenty-two woodcuts, all of great 



excellence, have been added to the illustrations. Sciences. 



with skin diseases. The present edition may be 
commended as being an exposition of the subject 
fully up to the present state of our knowledge. 
— The Chicaao Clinical Review. 

Dr. Hyde's book may be heartily commended 
to the student and practitioner alike as one of the 
best exponents of the subject now before the pro- 
fession. — The American Journal of the Medical 



The excellence of the chapters on treatment, to- 
gether with the care that has been bestowed on 
subjects that have acquired new interest, make 
the book one to be warmly recommended. — Bos- 
ton Medical and Surgical Journal. 

The qualities that have contributed so much to 
its previous popularity still remain. The chief of 
these unquestionably are the standpoint of prac- 
tical medicine from which it speaks and its wealth 
of therapeutical information. The writer knows 
no book in which one can seek more satisfactorily 



Dr. Hyde is an experienced scholar as well as a 
competent author, and his former editions were 
received with approval by dermatologists as well 
as by those general practitioners who are inter- 
ested in the study and treatment of diseases of 
the skin. The treatise is one that affords much 
satisfaction in that it is a safe guide for both stu- 
dents and practitioners, either general or special, 
and particularly does it adapt itself to the use of 
dermatologists.— Buffalo Medical and Surgical Jour- 
nal. 



Taylor's Clinical Atlas of Venereal and Skin Diseases. 

A Clinical Atlas of Venereal and Skin Diseases: Including Diag- 
nosis, Prognosis and Treatment. By Eobert W. Taylor, A. M., M. D., Clinical Pro- 
fessor of Genito-Urinary Diseases in the College of Physicians and Surgeons, New York ; 
In eight large folio parts, and comprising 58 beautifully colored plates with 213 figures, 
and 431 pages of text with 85 engravings. Price per part, $2.50. Bound in one volume, 
half Eussia, $27 ; half Turkey Morocco, $28. For sale by subscription only. Specimen 
plates sent on receipt of 10 cents. A full prospectus sent to any address on application. 

Jackson's Ready-Reference Handbook of Skin Diseases. 

The Ready-Reference Handbook of Diseases of the Skin. By 

George Thomas Jackson, M. D., Professor of Dermatology, Woman's Medical College 
of the New York Infirmary. In one 12mo. volume of 544 pages, with 50 illustrations 
and a colored plate. . Cloth, $2.75. 



Intended to serve as a reference book for the 
general practitioner, "no attempt has been made 
to discuss debatable questions," and "hence pa- 
thology and etiology do not receive as full consid- 
eration as symptomatology, diagnosis and treat- 



ment." It treats in alphabetical order of the dis- 
eases of the skin and their management. This 
book seems to us the best of its class that has 
yet appeared.— Boston Medical and Surgical Jour- 
nail 



Morris on the Skin.— Just Ready. 

Diseases Of the Skin. An Outline of the Principles and Practice of Der- 
matology. By Malcolm Morris, F. K C. S., Surgeon to the Skin Department, St. Mary's 
Hospital, London. In one bquare octavo volume of 565 pages, with 19 chromo-lithographic 
figures and 17 engravings. Cloth, $3.50. 

The present work is entirely new and is place within the intelligent command of the 
designed to be essentially clinical and practical I reader the very full recommendations as to 
in scope. Diagnosis, symptoms, causation and treatment. Every part of the book represents the 
prognosis receive sufficient space to convey a I most modern knowledge and methods.— Pacific 
clear idea of the nature of each disease, and to | Medical Journal, May, 1893. 

Pye-Smith on Diseases of the Skin. 

A Handbook of Diseases of the Skin. By P. H. Pye-Smith, M. D., 
F. K. S , Physician to Guy's Hospital, London. In one octavo volume of 407 pages, 
with 26 illustrations, 23 of which are colored. Cloth, $2.00. 

The book is an excellent one, and we commend J known as one of the eminent physicians to Guy's 
it to all interested in the subject. It is written by Hospital, and we have no hesitation in saying 
one entirely familiar with skin diseases, both I that he has written an original and valuable 
from the standpoint of the specialist and the I handbook on skin diseases, sound and practical 
general practitioner. Dr. Pye-Smith is favorably \ in all its bearings.— International Med. Magazine. 

Jamieson on Diseases of the Skin.— Third Edition. 

Diseases of the Skin. A Manual for Students and Practitioners. By 
W. Allan Jamieson, M. D., Lecturer on Diseases of the Skin, School of Medicine, Edin- 
burgh. Third edition, revised and enlarged. In one octavo volume of 656 pages, with 
woodcut and 9 double-page chromo-lithographic illustrations. Cloth, $6.00. 



The scope of the work is essentially clinical, lit 
tie reference being made to pathology or disputed 
theories. Almost every subject is followed by 
illustrative cases. The pages are filled with inter- 
est to all those occupied with skin diseases. The 



general practitioner will find the book of great 
value in matters of diagnosis and treatment. The 
latter is quite up to date, and the formulae have 
been selected with care. — Medical Record. 



WILSON'S STUDENT'S BOOK OF CUTANEOUS 
MEDICINE AND DISEASES OF THE SKIN. 



In one handsome small octavo volume of 535 
pages. Cloth, $3.50. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Diseases of Women. 



27 



The American Systems of Gynecology and Obstetrics. 

Systems of Gynecology and Obstetrics, in Treatises by American 
Authors. Gynecology edited by Matthew D. Mann, A. M., M. D., Professor of Obstetrics 
and Gynecology in the Medical Department of the University of Buffalo; and Obstet- 
rics edited by Barton Cooke Hirst, M. D., Associate Professor of Obstetrics in the 
University of Pennsylvania, Philadelphia. In four very handsome octavo volumes, con- 
taining 3612 pages, 1092 engravings and 8 plates. Complete work now ready. Per vol- 
ume: Cloth, $5.00; leather, $6.00; half Russia, $7.00. For sale by subscription only. 
Address the Publishers. Full descriptive circular free on application. 
In our notice of the "System of Practical Medi- j It, like the other, has been written exclusively 



cine by American Authors," we made the follow- 
ing statement:— "It is a work of which the pro- 
fession in this country can feel proud. Written 
exclusively by American physicians who are ac- 
quainted with all the varieties of climate in the 
United States, the character of the soil, the man- 
ners and customs of the people, etc., it is pecul- 
iarly adapted to the wants of American practition- 
ers of medicine, and it seems to us that every one 
of them would desire to have it." Every word 
thus expressed in regard to the "American Sys- 
tem of Practical Medicine" is applicable to the 
" System of Gynecology by American Authors." 



by American physicians who are acquainted with 
all the characteristics of American people, who are 
well informed in regard to the peculiarities of 
American women, their manners, customs, modes 
of living, etc. As every practising physician is 
called upon to treat diseases of females, and as 
they constitute a class to which the family phy- 
sician must give attention, and cannot pass over 
to a specialist, we do not know of a work in any 
department of medicine that we should so strongly 
recommend medical men generally purchasing.— 
Cincinnati Med. News. 



Emmet's Gynaecology — Third Edition. 

The Principles and Practice of Gynaecology ; For the use of Students 
and Practitioners of Medicine. By Thomas Addis Emmet, M. D., LL. D., Surgeon to 
the Woman's Hospital, New York, etc. Third edition, thoroughly revised. In one 
large and very handsome 8vo. vol. of 880 pp., with 150 illus. Cloth, $5 ; leather, $6. 

the privilege thus offered them of perusing the 
views and practice of the author. His earnestness 
of purpose and conscientiousness are manifest. 



We are in doubt whether to congratulate the 
author more than the profession upon the appear- 
ance of the third edition of this well-known work. 
Embodying, as it does, the life-long experience of 
one who has conspicuously distinguished himself 
as a bold and successful operator, and who has 
devoted so much attention to the specialty, we 
feel sure the profession will not fail to appreciate 



He gives not only his individual experience but 
endeavors to represent the actual state of gynae- 
cological science and art. — British Medical Jour- 
nal. 



Tait's Diseases of Women and Abdominal Surgery. 

Diseases of Women and Abdominal Surgery. By Lawson Tait, 
F. E. C. S., Professor of Gynecology in Queen's College, Birmingham, late President of 
the British Gynecological Society, Fellow American Gynaecological Society. In two 
octavo vols. Vol. I., 554 pp., 62 engravings and 3 plates. Cloth, $3. Vol. II., preparing. 
Mr. Tait never writes anything that does not I on the technique of surgical operations, ingenious 
command attenticn by reason of the originality of theories on pathology, daring innovations on long- 
his ideas and the clear and forcible manner in j established lines — these succeed one another 
which they are expressed. This is eminently ! with a bewildering rapidity. His position has 
true of the present work. Germs of truth are long been assured. We cannot repress our admi- 
thickly scattered throughout; single happily : ration for the restless genius of the great sur- 
worded sentences express what another author geoa. — American Journal of the Medical Sciences. 
would have expanded into pages. Useful hints ! 

Edis on Diseases of Women. 

The Diseases of Women. Including their Pathology, Causation, Symptoms, 
Diagnosis and Treatment. A Manual for Students and Practitioners. By Arthur W. 
Edis, M. D., Lond., F. E. C. P., M. E. C. S., Assistant Obstetric Physician to Middlesex 
Hospital, late Physician to British Lying-in-Hospital. In one handsome octavo volume 
of 576 pages, with 148 illustrations. Cloth, $3.00 ; leather, $4.00. 

The special qualities which are conspicuous 
are thoroughness in covering the whole ground, 
clearness of description and conciseness of state- 
ment. Another marked feature of the book is 



the attention paid to the details of many minor 
surgical operations and procedures, as, for 
instance, the use of tents, application of leeches, 
and use of hot water injections. These are 



among the more common methods of treat- 
ment, and yet very little is said about them in 
many of the text-books. The book is one to be 
warmly recommended especially to students and 
general practitioners, who need a concise but com- 
plete resume" of the whole subject. Specialists, too, 
will find many useful hints in its pages. — Boston 
Medical and Surgical Journal. 



Duncan on Diseases of Women. 

Clinical Lectures on the Diseases of Women ; Delivered in Saint 
Bartholomew's Hospital. By J. Matthews Duncan, M. D., LL. D., F. E. S. E., etc. 
In one octavo volume of 175 pages. Cloth, $1.50. 



HODGE ON DISEASES PECULIAR TO WOMEN. 
Including Displacements of the Uterus. Second 
edition, revised and enlarged. In one beauti- 
fully printed octavo volume of 519 pages, with 
original illustrations. Cloth, $4.50. 



WEST'S LECTURES ON THE DISEASES OF 
WOMEN Third American from the third Lon- 
don edition. In one octavo volume of 543 pages. 
Cloth, $3.75 ; leather, $4.75. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



28 



Diseases of Women — (Continued). 



Thomas & Munde on Diseases of Women.— Sixth Edition. 

A Practical Treatise on the Diseases of "Women. By T. Gaillard 
Thomas, M. D., LL. D., Emeritus Professor of Diseases of Women in the College of 
Physicians and Surgeons, New York, and Paul F. Munde, M. D., Professor of Gynecol 
ogy in the New York Polyclinic. Sixth edition, thoroughly revised and rewritten 
by Dr. Munde. In one large and handsome octavo volume of 824 pages, with 347 
illustrations, of which 201 are new. Cloth, $5.00 ; leather, $6.00. 

book we know, and will be of especial value to the 



The profession has sadly felt the want of a text- 
book on diseases of women, which should be com- 
prehensive and at the same time not diffuse, 
systematically arranged so as to be easily grasped 
by the student of limited experience, and which 
should embrace the wonderful advances which 
have been made within the last two decades. 
Dr. Munde brings to his work a most practical 
knowledge of the subjects of which he treats and 
an exceptional acquaintance with the world's liter- 
ature of this important branch of medicine. The 
result is what is, perhaps, on the whole, the best 
practical treatise on the subject in the English 
language. It is, as we have said, the best text- 



general practitioner as well as to the specialist. 
The illustrations are very satisfactory. — Boston 
Medical and Surgical Journal. 

This work, which has already gone through five 
large editions, and has been translated into 
French, German, Spanis-h and Italian, is too well 
known to require commendation. It continues to 
be the most practical and at the same time the 
most complete treatise upon the subject in print, 
the changes that have been made only increasing 
its value. — The Archives of Gyne'ology, Obstetrics 
and Pediatrics. 



many years of research upon a subject embracing 
some of the commonest, most painful and hitherto 
hopeless of human affections. As this work deals 
exhaustively with tumors it will furnish the 
surgeon, gynecologist and general practitioner 
with indispensable aid in the early recognition 
and successful treatment of this class of disease. 



Sutton on Tumors, Innocent and Malignant. 

Tumors, Innocent and Malignant. Their Clinical Features and Ap- 
propriate Treatment. By J. Bland Sutton, F. K. C. S., Assistant Surgeon to the Mid- 
dlesex Hospital, London. In one very handsome octavo volume of 526 pages, with 250 
engravings and 9 full page plates. Cloth, $4.50. 

Sutton has without doubt written the best 
general work on tumors which has yet appeared 
in the English language. We urge all of our 
readers to get this splendid book. — The St. Louis 
Medical and Surgical Journal. 

The author is widely known as one of the fore- 
most surgeons and pathologists of London. His 

ability has already been recognized in his earlier — The Omaha Clinic, 
works. In the present instance he has spent | 

Sutton on the Ovaries and Fallopian Tubes. 

Surgical Diseases of the Ovaries and Fallopian Tubes, including 
Tubal Pregnancy. By J. Bland Sutton, F. K. C. S., Assistant Surgeon to the 
Middlesex Hospital, London. In one square octavo volume of 544 pages, with 119 
engravings and 5 colored plates. Cloth, $3.00. 

is not for them alone; the general practitioner 
needs just such a book. It will be of immense 
service to him in the study of pelvic diseases, and 
will assuredly open his eyes to the progress made 
by conscientious, painstaking workers like Dr. 
Sutton in the field of pathology and differential 
diagnosis. — International Medical Magazine. 



This is not a book to be read and then shelved ; 
it is one to be studied. It is not based upon 
hypotheses but upon facts. It makes pathology 
practical, and inculcates a practice based upon 
pathology. It is succinct, yet thorough; practi- 
cal, yet scientific; conservative, yet bold. It is 
probably on the table of all gynecologists; but it 



Davenport's Non-Surgical Gynaecology.— Second Edition. 

Diseases of Women, a Manual of Non-Surgical Gynecology. 

Designed especially for the Use of Students and General Practitioners. By Francis 
H. Davenport, M. D., Assistant in Gynaecology in the Medical Department of Harvard 
University. Second edition. In one 12mo. vol. of 314 pages, with 107 illus. Cloth, $1.75. 

the actual test of experience, and being concisely 
and clearly written, conveys a great amount of in- 
formation in a convenient space. — Annals of Gynce- 



Many valuable volumes already exist on the 
surgical aspects of gynecology, but scant attention 
has been paid in recent years to the non-surgical 
treatment of women's diseases. The present 
volume, dealing with nothing which has not stood 



cology and Pcediatry. 



May's Manual oi Diseases of Women.— Second Edition. 

A Manual of theDiseases of Women. Being a concise and systematic 
exposition of the theory arid practice of gynecology. By Charles H. May, M. D., 
late House Surgeon to Mount Sinai Hospital, New York. Second edition, edited by 
L. S. Bait, M. D., Attending Gynecologist at the Harlem Hospital, N. Y. In one 12mo. 
volume of 360 pages, with 31 illustrations. Cloth, $1.75. 



This is a manual of gynecology in a very con- 
densed form, and the fact that a second edition 
has been called for indicates that it has met with 
a favorable reception. It is intended, the author 
tells us, to aid the student who after having care- 
fully perused larger works desires to review the 
subject, and he adds that it may be useful to the 
practitioner who wishes to refresh his memory 



rapidly but has not the time to consult larger 
works. We are much struck with the readiness 
and convenience with which one can refer to any 
subject contained in this volume. Carefully com- 
piled indexes and ample illustrations also enrich 
the work. This manual will be found to fulfil its 
purposes very satisfactorily. — The Physician and 
Surgeon. 



ASHWELL'S PRACTICAL TREATISE ON THE 
DISEASES PECULIAR TO WOMEN. Third 



American from the third and revised London 
edition. In one 8vo. vol., pp. 520. Cloth, $3.50. 



Lea Brothers & Co., Publishers, 706, 708 &710 Sansom Street, Philadelphia. 



Obstetrics, 



29 



Playfair's Midwifery.— New (8th) Edition. Just Ready. 

A Treatise on the Science and Practice of Midwifery. By W. S. 

Playfair, M. D., F. K. C. P., Professor of Obstetric Medicine in King's College, Lon- 
don, Examiner in Midwifery in the Universities of Cambridge and London, and to the 
Royal College of Physicians. Sixth American, from the eighth English edition. Edited, 
with additions, by Robert P. Harris, M. D. In one handsome octavo volume of 697 
pages, with 217 engravings and 5 plates. Cloth, $4.00 ; leather, $5.00. 

treatise was readily adopted by our colleges as a 
text-book. Students therefore became familiar 
with it at once, and obstetricians have followed 
it through its several editions with interest and 
satisfaction. This work of Play fair must occupy 
a foremost place in obstetric medicine as a safe 
guide to both student and obstetrician. It holds 
a place among the ablest English speaking author- 
ities on the obstetric art. — Buffalo Medical and 
Surgical Journal, March, 1894. 

The author's object has been to place in the 
hands of his readers an epitome oi the science 
and practice of midwifery, which embodies all 
recent advances, and especially to dwell on the 
practical part of the subject, so as to make his 
books a reliable guide to the doctor in the practice 
of this most important and responsible branch of 
medicine. The demand for this eighth edition of 
the work testifies to the success with whifh the 
author has executed his purpose. — The Medical 
Fortnightly, July, 1894. 



This work has long occupied a prominent posi- 
tion both as a text-book and book of reference in 
this country and in England. Numerous students 
have gleaned valuable suggestions from its pages, 
and its practical character and the author's ability 
for clear and concise writing are well known. 
Taking a broad view of the work, it must certainly 
be termed an admirable book.— The American 
Journal of Obstetrics, February, 1894. 

This well-known treatise has been either a text- 
book or work of reference in most medical schools 
for the past seventeen years, and in the numerous 
editions which have appeared it has been kept 
constantly in the foremost rank of the books which 
have been written on this subject, and is a work 
which can be conscientiously recommended to the 
profession.— The Albany Med. Annals, March, 1894. 

Since 1877 Playfair has been accepted as author- 
ity in the department of obstetrics. When his 
first edition was issued it was found to be such a 
clear exposition of the subject that Playfair's 



Parvin's Science and Art of Obstetrics.— New (3d) Edition. 

The Science and Art of Obstetrics. By Theophiltjs Parvin, M. D., 
LL. D., Professor of Obstetrics and the Diseases of Women and Children in Jefferson 
Medical College, Philadelphia. New (third) edition. In one handsome 8vo. volume of 
about 700 pages, with about 250 engravings and a colored plate. In press. 

King's Manual of Obstetrics.— New (6th) Edition. In Press. 

A Manual of Obstetrics. By A. F. A. King, M. D., Professor of Obstetrics 
and Diseases of Women in the Medical Department of the Columbian University, Wash- 
ington, D. C, and in the University of Vermont, etc. New (sixth) edition. In one 12mo. 
volume of about 475 pages, with about 175 illustrations. 
A notice of the previous edition is appended. 
So comprehensive a treatise could not be brought | unnecessary ornamentation. Therefore we say 



within the limits of a book of this size were not 
two things especially true. First, Dr. King is a 
teacher of many years' experience, and knows 
just how to present his subjects in a manner for 
them to be best received ; and, secondly, he can 
put his ideas in a clear and concise form. In 
other words, he knows how to use the English 
language. He gives us the plain truth, free from 



there are nine hundred pages of matter between 
the covers of this manual of four hundred and 
fifty pages. We cannot imagine a better manual 
for the hard-worked student; while its clear and 
practical teachings make it invaluable to the busy 
practitioner. The illustrations add much to the 
subject matter.— The National Medical Review. 



Barnes' System of Obstetric Medicine and Surgery. 

A System of Obstetric Medicine and Surgery, Theoretical and 
Clinical. For the Student and the Practitioner. By Robert Barnes, M. D., Phys- 
ician to the General Lying-in Hospital, London, and Fancourt Barnes, M. D., Obstetric 
Physician to St. Thomas' Hospital, London. The Section on Embryology by Prof. Milnes 
Marshall. In one 8vo. volume of 872 pp., with 231 illustrations. Cloth, $5 ; leather, $6. 

Davis' Obstetrics.— Preparing. 

A Treatise on Obstetrics. For Students and Practitioners. By Edward 
P. Davis, A. M., M. D., Professor of Obstetrics and Diseases of Infancy in the Philadel- 
phia Polyclinic, Clinical Professor of Obstetrics in the Jefferson Medical College of 
Philadelphia. In one very handsome octavo volume of 500 pages, richly illustrated. 

Landis on Labor and the Lying-in Period. 

The Management of Labor, and of the Lying-in Period. 

By Henry G-. Landis, A. M., M. D., Professor of Obstetrics and the Diseases of Women 
in Starling Medical College, Columbus, Ohio. In one handsome 12mo. volume of 334 
pages, with 28 illustrations. Cloth, $1.75. 



RAMSBOTHAM'S PRINCIPLES AND PRAC- 
TICE OF OBSTETRIC MEDICINE AND 
SURGERY. In one octavo volume of 640 pages, 
with 64 full- page plates and 43 woodcuts in the 
text. Leather, $7. 

TANNER ON PREGNANCY. Octavo, 490 pages, 
colored plates, 16 cuts. Cloth, $4.25. 



CHURCHILL ON THE PUERPERAL FEVER 
AND OTHER DISEASES PECULIAR TO WO- 
MEN. In one 8vo. vol. of 464 pages. Cloth, $2.50. 

LEISHMAN'S SYSTEM OF MIDWIFERY, IN- 
CLUDING THE DISEASES OF PREGNANCY 
AND THE PUERPERAL STATE. Octavo. ' 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



30 Dis. of Children, Obstetrics — (Cont'd), Manuals. 



Smith on Children.— Seventh Edition. 

A Treatise on the Diseases of Infancy and Childhood. By 

J. Lewis Smith, M. D., Clinical Professor of Diseases of Children in the Bellevue Hospital 
Medical College, New York. New (seventh) edition, thoroughly revised and rewritten. 
In one handsome octavo volume of 881 pages, with 51 illus. Cloth, $4.50 ; leather, $5.50. 



We have always considered Dr. Smith's book as 
one of the very best on the subject. It has always 
been practical— a field book, theoretical where 
theory has been deduced from practical experi- 
ence. He takes his theory from the bedside and 
the pathological laboratory. The very practical 
character of this book has always appealed to us. 
It is characteristic of Dr. Smith in all his writings 
to collect whatever recommendations are found in 
medical literature, and his search has been wide. 
One seldom fails to find here a practical suggestion 
after search in other works has been in vain. In 
the seventh edition we note a variety of changes 
in accordance with the progress of the times. It 
still stands foremost as the American text-book. 
The literary style could not be excelled, its advice 



is always conservative and thorough, and the 
evidence of research has long since placed its 
author in the front rank of medical teachers.— 
The American Journal of the Medical Sciences. 

In the present edition we notice that many of 
the chapters have been entirely rewritten. Full 
notice is taken of all the recent advances that 
have been made. Maiay diseases not previously 
treated of have received special chapters. The 
work is a very practical one. Especial care has 
been taken that the directions for treatment shall 
be particular and full. In no other work are such 
careful instructions given in the details of infant 
hygiene and the artificial feeding of infants.— 
Montreal Medical Journal. 



Herman's First Lines in Midwifery. 

First Lines in Midwifery: a Guide to Attendance on Natural 
Labor for Medical Students and Midwives. By G. Ernest Herman, M. B., 
F. B.C. P., Obstetric Physician to the London Hospital. In one 12mo. volume of 198 
pages, with 80 illustrations. Cloth, $1.25. See Student's Series of Manuals, below. 

This is a little book, intended for the medical I will prove valuable to the beginner in midwifery 
student and the educated midwife. The work and could be read with advantage by the majority 
is written in a plain, simple style, and is as of practitioners, old and young.— The Medical 
much as possible devoid of technical terms. It | Fortnightly. 

Owen on Surgical Diseases of Children. 

Surgical Diseases of Children. By Edmund Owen, M. B., F. B. C. S., 

Surgeon to the Children's Hospital, Great Ormond Street, London. In one 12mo. vol- 
ume of 525 pages, with 4 chromo-lithographic plates and 85 woodcuts. Cloth, $2.00. 
See Series of Clinical Manuals, below. 



Student's Series of Manuals. 



A Series of Fifteen Manuals, for the use of Students and Practitioners of Medicine and Surgery, 
written by eminent Teachers or Examiners, and issued in pocket-size 12mo. volumes of 300-540 pages, 
richly illustrated and at a low price. 'J he following volumes are now ready: Luff's Manual of Chem- 
istry, §2 \ Herman's First Lines in Midwifery, $1.25; Treves' Manual of Surgery, by various writers, in 
three volumes, per set, $6; Bell's Comparative Anatomy and Physiology, $2; Gould's Surgical 
Diagnosis, 82; Robertson's Physiological Physics, $2 ; Bruce's Materia Medicadnd Therapeutics (5th edi- 
tion), $1.50; Power's Human Physiology (2d edition), $1.50; Clarke and Lockwood's Dissectors'' Man- 
ual, $1.50 ; Ralfe's Clinical Chemistry,"$\. 50 ; Treves' Surgical Applied Anatomy, $2; Pepper's Surgical 
Pathology, $2; and Klein's Elements of Histology (4th edition), $1.75. The following is in press 
Pepper's Forensic Medicine. For separate notices see index on last page. 



Series of Clinical Manuals. 



In arranging for this Series it has been the design of the publishers to provide the profession with 
a collection of authoritative monographs on important clinical subjects in a cheap and portable form. 
The volumes contain about 550 pages and are freely illustrated by chromo-lithographs and wood- 
cuts. The following volumes are now ready: Ball on the Rectum and Anus, second edition, $2.25; 
Yeo on Food in Health and Disease,$2; Broadbent on the Pulse, $1.75; Carter & Frost's Ophthalmic 
Surgery, $2.25 ; Hutchinson on Syphilis, $2.25; Marsh on the Joints, $2; Owen on Surgical Diseases 
of Children, $2; Morris on Surgical Diseases of the Kidney, $2.25; Pick on Fractures and Disloca- 
tions, $2; Butlin on the Tongue, $3.50; Treves on Intestinal Obstruction, $2; and Savage on Insanity 
and Allied Neuroses, $2. The following is in preparation: Lucas on Diseases of the Urethra. For sepa- 
rate notices see index on last page. 

Hartshorne's Conspectus of the Medical Sciences. 

A Conspectus of the Medical Sciences ; Containing Handbooks on Anat- 
omy, Physiology, Chemistry, Materia Medica, Practice of Medicine, Surgery and Obstetrics. 
By Henry Hartshorne, A. M., M. D., LL. D., lately Professor of Hygiene in the Uni- 
versity of Pennsylvania. Second edition, thoroughly revised and greatly improved. In 
one large royal 12mo. vol. of 1028 pages, with 477 illus. Cloth, $4.25 ; leather, $5.00. 

PARRY ON EXTRA-UTERINE PREGNANCY: 
Its Clinical History, Diagnosis, Prognosis and 
Treatment. Octavo, 272 pages. Cloth, $2.50. 

CONDIE'S PRACTICAL TREATISE ON THE 
DISEASES OF CHILDREN. Sixth edition, re- 
vised and augmented. In one octavo volume of 
779 naerps 0!loth, $5.25 ; leather, $6.25. 

LUDLOW'S MANUAL OF EXAMINATIONS. A 
Manual of Examinations upon Anatomy, Physi- 
ology, Surgery, Practice of Medicine, Obstetrics, 
Materia Medica, Chemistry, Pharmacy and 
Therapeutics. To which is added a Medical 
Formulary. By J. L. Ludlow, M. D., Consulting 



Physician to the Philadelphia Hospital, etc. 
Third edition, thoroughly revised, and greatly 
enlarged. In one 12mo." volume of 816 pages, 
with 370 illustrations. Cloth, $3.25; leather, $3.75. 

WEST ON SOME DISORDERS OF THE NERV- 
OUS SYSTEM IN CHILDHOOD. In one small 
12mo. volume of 127 pages. Cloth, $1.00. 

WINCKEL'S COMPLETE TREATISE ON THE 
PATHOLOGY AND TREATMENT OF CHILD- 
BED. For Students and Practitioners. Trans- 
lated from the second German edition, by J. R. 
Chadwick, M. D. Octavo 484 pages. Cloth, $4.00. 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



fledical Jurisprudence, Historical. 



31 



Taylor's Medical Jurisprudence.— Twelfth Edition. 

A Manual of Medical Jurisprudence. By Alfred S. Taylor, M. D., 
Lecturer on Med. Jurisprudence and Chemistry in Guy's Hosp., London. New American 
from the 12th English edition. Thoroughly revised by Clark Bell, Esq., of the New- 
York Bar. In one octavo volume of 787 pages, with 56 illus. Cloth, $4.50; leather, $5.50. 
This is a complete revision of all former Ameri- ! into the criminal courts. The editor has given to 
can and English editions of this standard book, j two professions a reference-book to be relied upon. 
This edition contains a large amount of entirely j — The American Journal of the Medical Sciences. 
new matter, many portions of the book having j No library is complete without Taylor's Medical 
been rewritten by the editor. Many cases and 
authorities have been cited, and the citations 
brought down to the latest date. The book has 



long been a standard treatise on the subject of 
medical jurisprudence, and has gone through 
many editions— twelve English and eleven Ameri- 
can. Mr. Clark Bell has enlarged and improved 
what already seemed complete, by bringing his 
many citations of cases down to date to meet the 

E resent law ; and by adding much new matter he 
as furnished the medical profession and the bar 
with a valuable book of reference, one to be relied 
upon in daily practice, and quite up to the present 
needs, owing to its exhaustive character. It 
would seem that the book is indispensable to the 
library of both physician and lawyer, and particu- 
larly the legal practitioner whose duties take him 



j Jurisprudence, as its~authorily is accepted and un- 
j questioned by the courts. — Buffalo Medical and 
| Surgical Journal. 

There is no other work upon the subject which 
has been so uniformly recognized or so widely 
quoted and followed by courts in England and this 
country. This eleventh American edition is fully 
abreast with the most recent thought and knowl- 
edge. On the basis of his own researches, of the 
investigations of scientists throughout the world, 
and of the decisions of our own courts, Mr. Bell 
has incorporated in it a wealth of practical sug- 
gestion and t instructive illustration which cannot 
fail to strengthen the hold it has so long had 
upon the profession. — The Criminal Law Magazine 
and Reporter. 



By the Same Author. 
Poisons in Relation to Medical Jurisprudence and Medicine. Third 
American, from the third and revised English edition. In one large octavo volume of 788 
pages. Cloth, $5.50 ; leather, $6.50. 

Lea's Superstition and Force.— New Edition. Just Ready. 

Superstition and Force: Essays on The Wager of Law, The 
Wager of Battle, The Ordeal and Torture. By Henry Charles Lea, 
LL. D., New (4th) edition, revised and enlarged. Royal 12mo., 629 pages. Cloth, $2.75. 



Both abroad and at home the work has been 
accepted as a standard authority, and the author 
has endeavored by a complete revision and con- 
siderable additions to render it more worthy of 
the universal favor which has carried it to a 
fourth edition. The style is severe and simple, 
and yet delights with its elegance and reserved 
strength. Tne known erudition and fidelity of 
the author are guarantees that all possible origi- 
nal sources of information have been not only 
consulted but exhausted. The subject matter is 



handled in such an able and philosophic man- 
ner that to read and study it is a step toward 
liberal education. It is a comfort to read a book 
that is so thorough, well conceived and well done. 
We should like to see it made a text-book in our 
law schools and prescribed course for admission 
to the bar. — Legal Intelligencer. 

A work as remarkable for the wealth of histori- 
cal material treated as for the masterly style of 
the exposition.— London Saturday Review. 



By the same Author. 
Chapters from the Religious History of Spain.— In one 12mo. volume 
of 522 pages. Cloth $2.50. 



The width, depth and thoroughness of research 
which have earned Dr. Lea a high European place 
as the ablest historian the Inquisition has yet 
found are here applied to some side-issues of that 
great subject. We have only to say of this volume 



that it worthily complements the author's earlier 
studies in ecclesiastical history. His extensive 
and minute learning, much of it from inedited 
manuscripts in Mexico, appears on every page.— 
London Antiquary. 



In one 8vo. volume of 219 



By the same Author. 
The Formulary of the Papal Penitentiary. 

pages, with a frontispiece. Cloth, $2.50. Just Heady. 

By the Same Author. 
Studies in Church History. The Bise of the Temporal Power— Ben- 
efit of Clergy— Excommunication— The Early Church and Slavery. Sec- 
ond and revised edition. In one roy al octavo volume of 605 pages. Cloth, $2.50. 



The author is preeminently a scholar; he takes 
up every topic allied with the leading theme and 
traces it out to the minutest detail with a wealth 
of knowledge and impartiality of treatment that 
compel admiration. The amount of information 
compressed into the book is extraordinary, and 
the profuse citation of authorities and references 



makes the work particularly valuable to the student 
who desires an exhausti?e review from original 
sources. In no other single volume is the develop- 
ment of the primitive church traced with so much 
clearness and with so definite a perception of 
complex or conflicting forces.— Boston Traveller. 



By the Same Author. 
An Historical Sketch of Sacerdotal Celibacy in the Christian 
Church. Second edition, enlarged. In one octavo volume of 685 pages. Cloth, $4.50. 



This subject has recently been treated with very 
great learning and with admirable impartiality by 
an American author, Mr. Henry C. Lea. in bis His- 
tory of Saceraotal Celibacy, which is certainly one 
of the most valuable works that America has pro- 
duced. Since the great history of Dean Milman, j of European Morals, Chap. V. 
I know no work in English which has thrown I 



more light on the moral condition of the Middle 
Ages, and none which is more fitted to dispel the 
gross illusions concerning that period which posi- 
tive writers and writers of a certain ecclesiastical 
school have conspired to sustain. — Lecky's History 



Lea Brothers & Co., Publishers, 706, 708 & 710 Sansom Street, Philadelphia. 



Index to Catalogue of Medical Publications 



Lea Brothers &, Co., 

706, 708 & 710 Sansom Street, PHILADELPHIA. 



Abbott's Bacteriology .... 19 

Allen's anatomy 6 

American Journal of tbe Med- 
ical Sciences 2 

American Systems of Gynecol- 
ogy and Obstetrics 27 

American System of Practical 

Medicine 14 

American System of Dentistry 24 
American Text-Books of Dent- 
istry 24 

A shhurst's Surgery 20 

Ashwell on Diseases of Women 28 

Attfield's Chemistry 9 

Ball on tbe Rectum and Anus 21, 30 
Barnes' System of Obstetric 

Medicine and Surgery ... 29 
Bartholow on Cholera .... 16 
Bartholow on Electricity . . 16 
Basham on Renal Diseases . . 23 
Bell's Comparative Anatomy 

and Physiology 7, 30 

Bellamy's Surgical Anatomy . 6 

Berry on the Eye 23. 

Billings' National Medical Dic- 
tionary 4 

Black on the Urine 24 

Blandford on Insanity .... 18 

Bloxam's Chemistry 9 

Broadbent on the Pulse. . . 15, 30 
Browne on Koch's Remedy . . 17 
Browne on the Throat, Nose 

and Ear 17 

Bruce's Materia Medica and 

Therapeutics 13, 30 

Brunton's Materia Medica and 

Therapeutics 13 

Bryant's Practice of Surgery . 21 ! 
Bumstead and Taylor on Vene- 
real Diseases See Taylor . . 25 I 

Burnett on the Ear 24 

Butlin on the Tongue . . . 20, 30 ' 
Carpenter on the Use and Abuse 

of Alcohol 7 

Carpenter's Human Physiology 7 
Carter & Frost's Ophthalmic 

Surgery 23,30 

Caspari's Pharmacy 10 

Chambers on Diet and Regimen 16 
Chapman's Human Physiology 8 
Charles' Physiological and 

Pathological Chemistry ... 10 
C h e y n e on Wounds, Ulcers 

and Abcessess 22 

Churchill on Puerperal Fever . 29 
Clarke and Lockwood's Dissec- 
tors' Manual 6, 30 

Cleland's Dissector 6 

Clouston on Insanity ... .17 
Clowes' Practical Chemistry . 8 

Coats' Pathology 19 

Cohen's Applied Therapeutics 12 
Coleman's Dental Surgerv . . 24 
Condie on Diseases of Children 30 

Cornil on Syphilis 25 

Culver '& Hayden on Venereal 

Diseases 25 

Dalton on the Circulation . . 7 
Dalton's Human Physiology . 8 
Davenport on Dis of Women . 28 
Davis' Clinical Lectures ... 14 

Davis' Obstetrics 29 

Dennis' System of Surgery . . 22 
Dercum on Nervous Diseases . 18 | 
Dispensatory. The National . . 11 
Draper's Medical Physics ... 7 
Druitt's Modern Surgery ... 20 
Duane's Medical Dictionary . . 3 
Duncan on Diseases of Women 27 
Dungllson's Medical Dictionary 4 
Edes' Materia Medica and 

Therapeutics 12 

Edis on Diseases of Women . . 27 

Ellis' Anatomy 7 

Emmet's Gynaecology .... 27 

Erichsen's Surgery 21 

Farquharson's Therapeutics 

and Materia Medica .... 13 
Field's Manual of Diseases of 

the Ear 24 

Flint on Auscultation and Per- 
cussion 15 

Flint on Phthisis 13 

Flint on Respiratory Organs . 14 

Flint on the Heart 13 

Flint's Essays 13 

Flint's Practice of Medicine . . 13 
Folsom's Laws of U. S. on Cus- 
tody of Insane 17 

Foster's Physiology 8 

Fotnergill's Handbook of 

Treatment 15 

Fownes' Elementary Chemistry 9 
Fox on Diseases of the Skin . . 25 
Frankland and Japp's Inor- 
ganic Chemistry 8 



Fuller on the Lungs and Air 

Passages 17 

Fuller on Male Sexual Disorders 25 
Gant's Student's Surgery . . 20 
Gibbes' Practical Pathology . 19 
Gould's Surgical Diagnosis . 20, 30 
Gray on Nervous and Mental 

Diseases 18 

Gray's Anatomy 5 

Greene's Medical Chemistry . 9 
Green's Pathology and Morbid 

Anatomy 19 

Gross on Impotence and Sterility 25 
Gross on Urinary Organs ... 25 
Habershon on the Abdomen . 14 
Hamilton onFractures and Dis- 
locations 22 

Hamilton on Nervous Diseases 18 
Hardaway on the Skin ... 25 
Hare's Practical Therapeutics . 12 
Hare's System of Practical 

Therapeutics 12 

Hartshorne's Anatomy and 
Physiology ........ 6 

Hartshorne's Conspectus of the 

Medical Sciences . , . . . 30 
Hartshorne's Essentials of 

Medicine . . 13 

Hayem's Physical and Natural 

Therapeutics 16 

Herman's Midwifery .... 30 
Hermann's Experimental Phar- 
macology 13 

Herrick's Diagnosis 16 

Hill on Syphilis 25 

H i 1 1 i e r ' s Handbook of Skin 

Diseases 25 

Hirst & Piersol on Human 

Monstrosities 6 

Hoblyn's Medical Dictionary . 5 

Hodge on Women 27 

Hoffmann and Power's Chem- 
ical Analysis ....... 10 

Holden's Landmarks .... 6 

Holland's Medical Notes and 

Reflections . . , 14 

Holmes' Surgery ...... 20 

Holmes' System of Surgery . . *0 
Horner's Anatomy and Histology 6 

Hudson on Fever 13 

Hutchinson on Syphilis . . 25, 30 

Hyde on the Skin 26 

Jackson on the Skin . . . 26 
Jamieson on the Skin .... 26 
Jones on Nervous Disorders . 18 
Juler's Ophthalmic Science and 

Practice 23 

King's Manual of Obstetrics . . 29 

Klein's Histology 18, 30 

Landis on Labor 29 

La Roche on Pneumonia, Mala- 
ria, etc 17 

La Roche on Yellow Fever . . 13 
Laurence and Moon's Ophthal- 
mic Surgery 23 

Lawson on the Eye 23 

Lea's Chapters from Religious 

History of Spain 31 

Lea's Formulary of the Papal 

Penitentiary 31 

Lea's Sacerdotal Celibacy ... 31 
Lea's Studies in Church History 31 
Lea's Superstition and Force . 31 

Lee on Syphilis 25 

Lehmann's Chemical Physiology 7 
Leishman's Midwifery .... 29 
Lucas on the Urethra .... 30 
Ludlow's Manual of Examina- 
tions 30 i 

Luff's Manual of Chemistry . 9, 30 
Lyman's Practice of Medicine 14 

Lyons on Fe\er 13 

Maisch's Organic Materia "Medica 12 
Mackenzie on Nose and Throat 17 
Marsh on the Joints ... 20, 30 
May on Diseases of Women . . 28 

Medical News 1 

Medical News Physicians' Ledger 2 
Medical News Visiting List . . 2 
Miller's Practice of Surgery . . 20 
Miller's Principles of Surgery 20 
Mitchell on Nerve Injuries . . IS 
Morris on the Kidney . . . 23, 30 
Morris on the Skin ..... 26 
Musser's Medical Diagnosis . . 15 
National Dispensatory ... 11 
National Medical Dictionary . 4 
Nettleship on the Eye . . . 23 
Norris and Oliver on the Eye . 23 
Owen on Diseases of Children . 30 
Parry on Extra-Uterine Preg- 
nancy 30 

Parvin's Obstetrics 29 

Pavy on Digestive Disorders . 16 
Payne's General Pathology . . 19 
Pepper's Forensic Medicine . . 30 



Pepper's Surgical Pathology 18, 30 
Pepper's System of Medicine . 14 
Pick on Fractures and Disloca- 
tions 22, 30 

Pirrie's System of Surgery . 20 
Playfair on Nerve Prostration 

and Hysteria 17 

Playfair's Midwifery 29 

Politzer on the Ear . . . . 24 
Power's Human Physiology . 7, 30 
Purdy on Bright's Disease and 

Allied Affections 24 

Pye-Smith on the Skin ... 26 

Quiz Series 3 

Ralfe's Clinical Chemistry . 10, 30 
Ramsbotham on Parturition . 29 
Reichert's Physiology .... 7 
Remsen's Theoretical Chemistry 10 
Reynolds' System of Medicine . 14 
Richardson's Preventive Med. 16 
Roberts on Urinary Diseases . 24 
Roberts' Compend of Anatomy 7 

Roberts' Surgery 20 

Robertson's Physiological Phys- 
ics 7, 30 

Ross on Nervous Diseases . . 18 
Savage on Insanity, including 

Hysteria 18, 30 

Schafer's Histology . . . . 18 
Schorield's Physiology .... 8 
Schreiber on Massage .... 16 
Seiler on the Throat, Nose and »*■ 

Naso- Pharynx 17 

Senn's Surgical Bacteriology . 19 
Series of Clinical Manuals . . 30 
Simon's Manual of Chemistry 9 

Slade on Diphtheria 17 

Smith (Edw.) on Consumption 17 
Smith (J. Lewis) on Children . 30 
Smith's Operative Surgery . . 21 

Stille on Cholera 16 

StillS <fe Maisch's National Dis- 
pensatory 11 

Still6's Therapeutics and Mate- 
ria Medica 12 

Stimson on Fractures and Dis- 
locations 22 

Stimson's Operative Surgery . 22 
Students' Quiz Series .... 3 
Students' Series of Manuals . . 30 
Sturges' Clinical Medicine . . 14 
Sutton on the Ovaries and Fal- 
lopian Tubes 28 

Sutton on Tumors 28 

Tait's Diseases of Women and 

Abdominal Surgery .... 27 
Tanner on Signs and Diseases 

of Pregnancy 29 

Tanner's Manual of Clinical 

Medicine 14 

Tavlor's Atlas of Venereal and 

Skin Dieases 26 

Taylor's Index of Medicine . . 15 

Taylor on Poisons 31 

Taylor on Venereal Diseases . 25 
Taylor's Medical Jurisprudence 31 
Thomas & Munde on Women . 28 
Thompson on Stricture .... 23 
Thompson on Urinary Organs . 23 
Todd on Acute Diseases ... 14 
Treves' Manual of Surgery .21,30 
Treves on Intestinal Obstruc- 
tion 21,30 

Treves' Operative Surgery . . 21 
Treves' Student's Handbook of 

Surgical Operations . . . , 21 
Treves' Surgical Applied Anat- 
omy 6, 30 

Tuke on the Influence of the 

Mind on the Body 17 

Vaughan & Novy on Ptomaines 

and Leucomaines 10 

Visiting List, The Medical News 2 

Walshe on the Heart 14 

Watson's Practice of Physic . . 14 

Wells on the Eye 23 

West on Diseases of Women . 27 
West on Nervous Disorders in 

Childhood 30 

Wharton's Minor Surgery and 

Bandaging -1 

Whitla's Dictionary of Treat- 
ment 15 

Williams on Consumption . . 17 
Wilson's Handbook of Cutane- 
ous Medicine 26 

Wilson's Human Anatomy . . 6 
Winckel on Pathology and 

Treatment of Childbed ... 30 
Wohler's Organic Chemistry . 7 
Year-Books of Treatment for 

'86. '87. '91, 'P2. '93, '95 U 

Yeo's Medical Treatment ... 16 
Yeo on Food in Health and 

Disease 16, o0 

Young's Orthopedic Surgery . 20 



